scholarly journals Radiographic Union of Evans Osteotomy Without Fixation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
Megan R. Miles ◽  
Brian P. Gallagher ◽  
Katherine L. Mistretta ◽  
Nigel N. Hsu ◽  
Haijun Wang ◽  
...  
Keyword(s):  
Allogenic Bone ◽  
Lateral Column ◽  
First Metatarsal ◽  
Calcaneocuboid Joint ◽  
Calcaneal Osteotomy ◽  
Metatarsal Angle ◽  
Flexible Flatfoot ◽  
Lateral Column Lengthening ◽  
Allogenic Bone Graft

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used to correct flexible flatfoot deformities. There is no consensus on whether fixation is needed to avoid nonunion and calcaneocuboid subluxation when performing this osteotomy. We assessed the nonunion rate and correlated extent of subluxation with graft size in an unfixed Evans osteotomy with an allograft wedge and no pinning of the calcaneocuboid joint at any point in the largest series of the procedure to date. Surgeries were performed in patients undergoing flexible flatfoot reconstruction. Methods: We retrospectively reviewed 120 consecutive patients who had undergone 145 unfixed Evans osteotomies by a single surgeon with allogenic bone graft for flatfoot reconstruction between January 2013 and October 2017, with a mean follow-up of 62.5 (range 9.4-266.7) weeks. The calcaneocuboid joint was not pinned during the procedure. Data were collected using clinical and radiographical examination during regular follow-up. Results: A total of 137 feet (94.5%) underwent a double calcaneal osteotomy with an associated medial displacement calcaneal osteotomy (MDCO). There was one nonunion (0.69%). The mean time to union was 10.8 (range, 6.7-17.9) weeks. There was significant improvement in all radiographic parameters postoperatively, including calcaneal pitch, talonavicular uncoverage, anteroposterior and lateral talo-first metatarsal angle, lateral column length, and naviculocuboid overlap (p<0.05). Minor postoperative calcaneocuboid joint subluxation (1.51 +- 2.3 mm) occurred in 72 of 118 feet (61.0%) and had no correlation with wedge size (r=0.06; 95% CI, -0.13, 0.24; p=0.6). Conclusion: An unfixed Evans osteotomy for symptomatic flatfoot deformity resulted in a significant improvement in the radiographic alignment of the foot with an exceptionally rare nonunion rate. Detectable calcaneocuboid subluxation was common but minimal in extent and was not correlated with wedge size in this series in which wedges were less than 12 mm in the maximum dimension. This report represents the largest series of the Evans procedure to date.

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

2021 ◽  
pp. 107110072110513
Author(s):  
Yin-Chuan Shih ◽  
Chui Jia Farn ◽  
Chen-Chie Wang ◽  
Chung-Li Wang ◽  
Pei-Yu Chen
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Lateral Column ◽  
Metatarsal Angle ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity ◽  
The Mean

Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

scholarly journals Occupational Outcomes Of Reconstructive Surgery For Adult Acquired Flatfoot Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Michael Finnern ◽  
Claude Anderson ◽  
Paul Ryan
Keyword(s):  
Reconstructive Surgery ◽  
Recovery Period ◽  
The United States ◽  
Active Duty ◽  
Pes Planus ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Lateral Column Lengthening ◽  
The Military

Category: Hindfoot Introduction/Purpose: Reconstruction of a symptomatic adult flatfoot is an involved operation with a long recovery period. No previous studies have looked at the occupational or functional results of athletically active patients who have undergone this surgery. In the United States military, the rates of return to unrestricted active duty are unknown. Methods: A retrospective review of all active duty military patients who underwent a reconstructive surgery for adult acquired flatfoot surgery at a single institution from January 2001-2015 was performed. Surgical, inpatient, and outpatient databases were searched via CPT and ICD9 codes. Approximately 1300 cases with potential flatfoot reconstructive surgery were identified. Only those patients with the diagnosis of flatfoot treated with both a boney procedure and a soft tissue procedure were included. Patients had to have at least one year follow-up or follow-up to the point of maximum medical benefit as defined by the operative provider. Final disposition of the patients had to have been recorded in the medical record. Three possible outcomes were utilized in the review of this cohort: patient returned to duty without restrictions, patient returned to active duty with restrictions, or patient separated from active duty due all or in part to this medical condition. Results: Fifty patients met inclusion criteria. 30/50 patients (60%) remained on active duty with permanent duty restrictions, and only two of 50 patients (4%) returned to full duty without restrictions. 20/50 (40%) underwent a Medical Evaluation Board (MEB) to separate from the military. A difference was noted in terms of the hindfoot realignment procedure performed: the probability of an MEB is higher for those patients who had a lateral column lengthening procedure than those who were treated with a medializing calcaneal osteotomy. Conclusion: The sample size is the largest study to date of patients with surgical correction for symptomatic pes planus. The results demonstrate that a service member with symptomatic pes planus requiring surgery faces a 96% chance of failure to return to pre-injury level of function. While some (60%) were able to remain on active duty with restrictions, there is a 40% chance that service members will face separation from the military due to their foot pain. Furthermore, patients treated with a lateral column lengthening had a higher probability of being medically discharged than those who had a medializing calcaneal osteotomy.

scholarly journals Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for StageⅡB Adult- acquired Flatfoot Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Yunfeng Yang ◽  
Haichao Zhou ◽  
Yun Zhang
Keyword(s):  
Lateral Pressure ◽  
Biomechanical Analysis ◽  
Good Effect ◽  
Lateral Column ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Significant Difference ◽  
Significant Correction ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity

Category: Basic Sciences/Biologics Introduction/Purpose: To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage? B adult-acquired flatfoot deformity in cadaver. Methods: Six cadaver specimens were compressively loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results: Compared with the flatfoot model, the 2-,3-,4-, and 5-mm LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs. As the graft increased in size incrementally, lateral forefoot pressure increased consistently, and medial pressure decreased significantly except for the 2-mm LCL. Compared with the intact foot, the above angles of the LCLs showed no significant difference except for the 2- mm LCL. In terms of forefoot pressure, medial pressure of the 2-mm LCL and lateral pressure of the 3-, 4- and 5-mm LCLs showed statistical differences, but lateral pressure of the 3-mm LCL was not much more than the intact foot as compared to the 4- and 5-mm LCLs, which was still less than medial pressure. Conclusion: Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage? B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.

scholarly journals Effect of Lateral Column Lengthening Calcaneal Osteotomy on Radiographic Measurements of Foot Alignment

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Chris Anthony ◽  
Jessica Goetz ◽  
Adam Kruse ◽  
Andrew Kern ◽  
John Femino
Keyword(s):  
Cyclic Loading ◽  
Interobserver Agreement ◽  
Plantar Fascia ◽  
Flat Foot ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Metatarsal Angle ◽  
Foot Model ◽  
Lateral Column Lengthening ◽  
Foot Alignment

Category: Hindfoot Introduction/Purpose: Lateral column lengthening (LCL) with calcaneal osteotomy has been increasingly used for reconstruction in flexible flat foot reconstruction. The aims of this study were to 1) evaluate the effects of variably sized LCL blocks on the restoration of alignment in an acute flat foot cadaveric model; 2) create a computer algorithm to more objectively measure foot alignment; and 3) develop an acute flat foot model that does not require cyclic loading for creating a type IIB flat foot. Determining if overcorrection with lateral column lengthening can occur would provide guidance surgeons to avoid lateral column overload. A computer guided measurement program could make studies more comparable. An acute flat foot model would clarify the ligament deficiencies necessary to create a type IIB flat foot. Methods: A type IIB flat foot model was used in which the medial and medial-plantar fibers of the calcaneonavicular (CN), the interosseous talo-calcaneal (ITCL) and the cervical (CL) ligaments were transected. Metallic markers were placed in the PF origin. 3D weightbearing CT scans were obtained with the specimens in a custom jig that permitted loading with 100 lbs. (445 N). The jig allowed full pronation under load. Scans were obtained: intact, flat, and with 6, 8 and 10 mm LCL blocks. Simulated AP and lateral radiographs were created using a custom MATLAB program. A custom ImageJ plugin was created which guided measurement of Meary’s angle, naviculo-cuneiform overlap, AP talo-first metatarsal angle, and a novel plantar fascia (PF) distance and PF angle. The program automatically calculated midpoints and perpendicular lines from guided user input. Four observers performed all measurements in blinded and randomized fashion on two occasions greater than 12 weeks apart. Results: The ligament sectioning model reliably produced a type IIB flat foot as noted by talo-navicular sag, increased talar head uncovering (forefoot abduction) and divergence of the talus and calcaneus as seen on the AP weightbearing view (Figure 1). Cyclic loading was not required in any specimens and the remaining medial column ligaments were not sectioned. Intraobserver and interobserver comparisons indicated naviculo-cuneiform overlap and plantar fascia distance had excellent interobserver agreement and Meary’s and plantar fascia angle had good interobserver agreement (Figure 1). Lateral column lengthening trended toward overcorrection at 10 mm suggesting a possible threshold for over-correction. Conclusion: The trend toward overcorrection with 10 mm LCL may indicate a threshold for lateral column overload. Computer guided measurement may improve consistency when comparing studies. The PF measurements are not possible in vivo. The use of a heel centering ring might be a surrogate for the implanted metallic beads. The CL sectioning was essential for creating type IIB flat foot without cyclic loading. The CL has been noted to be a main subtalar stabilizer, but has not entered into mainstream discussions regarding flat foot. Changes that occurred with cyclic loading performed in other flat foot studies have not been defined.

Triple Arthrodesis with Lateral Column Lengthening for Treatment of Severe Planovalgus Deformity

1995 ◽  
Vol 16 (7) ◽  
pp. 395-400 ◽  
Author(s):  
Greg A. Horton ◽  
Brad W. Olney
Keyword(s):  
Indication For Surgery ◽  
Triple Arthrodesis ◽  
Lateral Column ◽  
First Metatarsal ◽  
Ambulatory Status ◽  
Foot Length ◽  
Primary Indication ◽  
Metatarsal Angle ◽  
Solid Fusion ◽  
Lateral Column Lengthening

Triple arthrodesis with lateral column lengthening through the calcaneocuboid joint was performed on 22 feet in 14 patients. The primary indication for surgery was severe symptomatic planovalgus deformity unresponsive to conservative measures. All patients achieved solid fusion within 12 weeks. No patient had a decline in ambulatory status. Excellent correction of deformity was achieved and maintained with an average correction of the talus first metatarsal angle of 25° in both the AP and lateral planes. Triple arthrodesis with lateral column lengthening provides for reliable arthrodesis and allows correction of severe planovalgus deformity while maintaining foot length.

Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity

2017 ◽  
Vol 39 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Stuart M. Saunders ◽  
Scott J. Ellis ◽  
Constantine A. Demetracopoulos ◽  
Anca Marinescu ◽  
Jayme Burkett ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Categorical Variables ◽  
Distributed Data ◽  
Level Of Evidence ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Outcome Scores ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity ◽  
Lateral Pain

Background: The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. Methods: We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). Results: The Evans group used a larger graft size ( P < .001) and returned more often for hardware removal ( P = .038) than the SLCO group. SLCO union occurred at a mean of 8.77 weeks ( P < .001), which was significantly lower compared with the Evans group ( P = .02). The SLCO group also had fewer nonunions ( P = .016). FAOS scores improved equivalently between the 2 groups. Lateral column pain, ability to exercise, and ambulation distance were similar between groups. Conclusion: Following SLCO, patients had faster healing times and fewer nonunions, similar outcomes scores, and equivalent correction of deformity. SLCO is a viable technique for lateral column lengthening. Level of Evidence: Level III, retrospective cohort study.

A biomechanical analysis of the effect of lateral column lengthening calcaneal osteotomy on the flat foot

2007 ◽  
Vol 22 (4) ◽  
pp. 472-477 ◽  
Author(s):  
George A. Arangio ◽  
Vikram Chopra ◽  
Arkady Voloshin ◽  
Eric P. Salathe
Keyword(s):  
Biomechanical Analysis ◽  
Flat Foot ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Lateral Column Lengthening

Surgical management of an isolated symptomatic talonavicular coalition: a paediatric perspective

2021 ◽  
Vol 14 (11) ◽  
pp. e243761
Author(s):  
Keval Patel ◽  
Abdullah Khawaja ◽  
Aman Patel ◽  
Michail Kokkinakis
Keyword(s):  
Paediatric Patient ◽  
Reconstructive Surgery ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Early Stage ◽  
Operative Management ◽  
Lateral Column ◽  
Iliac Crest Bone Grafting ◽  
Lateral Column Lengthening

Talonavicular (TN) coalition is a rare pathological union of the talus and navicular bones. We report the case of a 7-year-old girl with a symptomatic TN coalition, who underwent operative management with a lateral column lengthening procedure using autologous iliac crest bone grafting. There are no complications to report and the graft was incorporated at an early stage. At 3 year follow-up the patient has remained pain-free since the operation and maintained alignment. To our knowledge, this is the first reported case of TN coalition treated with reconstructive surgery in a paediatric patient.

scholarly journals Structural Effect of Long-Term Use of Medial Arch Support Insole on Children with Pediatric Flexible Flatfoot

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0014
Author(s):  
Jun Young Choi ◽  
Min Jin Kim ◽  
Jin Soo Suh
Keyword(s):  
Structural Effect ◽  
Hindfoot Alignment ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Flexible Flatfoot ◽  
Arch Support ◽  
Group 2 ◽  
Physeal Closure ◽  
Group 1

Category: Midfoot/Forefoot Introduction/Purpose: This prospective study aimed to rule out the effect of the normal physiologic maturation in applying medial arch support insole for patients with pediatric flexible flatfoot (PFFF). Methods: From January 2005 to June 2015, 18 patients (34 feet) in group 1 (insole was continuously applied) and 16 patients (32 feet) in group 2 (untreated group) were enrolled. A medial arch support insole was applied from age 10-11 years until radiographic physeal closure. Results: In group 1, the talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Moreover, no significant differences were found in any of the increments of the radiographic parameters between groups 1 and 2. Conclusion: Radiographic improvements were found in both medial arch support insole-treated and untreated groups even if all radiographic values were still within the abnormal range. This means that PFFF could be somehow improved with heel stretching exercise until the physes were closed. Further, hindfoot alignment remained unchanged regardless of the medial arch support insole application.

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