Plantar Pressures in Patients with and without Lateral Foot Pain After Lateral Column Lengthening

Background: Excessive varus alignment of the forefoot after lateral column lengthening has been reported to lead to overloading of the lateral foot. The purpose of this study was to investigate whether there is a difference between the Evans opening wedge calcaneal osteotomy (Evans) and the calcaneocuboid distraction arthrodesis (CCDA) with respect to lateral forefoot loading. Methods: In each of 12 matched pairs of cadaver feet, plantar pressure measurements of the intact specimens were obtained during simulated foot-flat and early heel-rise phases of gait and again after randomly performing the Evans procedure on one foot and the CCDA on the other foot. Cervical plate fixation was used for immediate stability. Results: Both procedures resulted in statistically significant increased loading of the lateral forefoot and decreased loading of the medial forefoot compared with the preoperative status. The relative increase in lateral pressures was statistically greater with the CCDA than with the Evans. The average increase in pressure under the fifth metatarsal head in the foot-flat phase was 46% ± 42% (range − 4% to 141%) with the Evans and 104% ± 58% (range 9% to 216%) with the CCDA ( p = 0.003). In the early heel-rise phase, the increase in pressure was 50% ± 43% (range 2% to 108%) and 96% ± 65% (range 12% to 263%), respectively ( p = 0.02). Conclusion: The experimental data suggest that lateral column overload may be more likely with the CCDA than with the Evans. Physicians should be aware of the likelihood of increasing lateral column loads with both the CCDA and the Evans procedure. It may be possible to avoid this problem by using less lateral column lengthening than the 1 cm used in this study or by considering a medial column arthrodesis or plantarflexion osteotomy to balance forefoot loading.

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Biomechanical Comparison of Hintermann and Evans Osteotomy for Lateral Column Lengthening

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00256 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0025

Author(s):

Kimberly Koury ◽

Beatrice Grasu ◽

Benjamin Stein ◽

Pooyan Abassi ◽

Brent Parks ◽

...

Keyword(s):

Peak Pressure ◽

Column Length ◽

Opening Wedge ◽

Lateral Column ◽

Plantar Pressures ◽

Lateral Column Lengthening ◽

Biomechanical Comparison ◽

Testing Condition ◽

Theoretical Risk ◽

Increased Pressure

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Both Evans and Hintermann procedures are opening wedge calcaneal osteotomies used for lateral column lengthening in flatfoot reconstruction. Risks of lateral column lengthening include lateral forefoot overload and increased calcaneocuboid (CC) joint pressure. The Evans osteotomy is preformed closer to the CC joint increasing the theoretical risk of higher CC pressures. The Hintermann technique is a more posteriorly located osteotomy developed to avoid destabilization of the anterior calcaneal fragment and subsequent CC joint incongruency. The purpose of this study is to biomechanically compare the Evans and Hintermann osteotomies through analysis of CC joint pressures and forefoot plantar pressures after sequential lengthening of the lateral column. Methods: A flatfoot model with radiographic confirmation was created in 10 matched cadaveric specimens which were then randomly selected to undergo either the Evans or Hintermann osteotomy. Specimens were physiologically loaded and the peak pressure of the CC joint and forefoot plantar pressures were measured under the following conditions: (1) intact foot, (2) flatfoot, and (3) sequential lengthening of the lateral column from 6 mm to 14 mm, in 2 mm increments. Results: Lateral column lengthening lead to significantly increased pressure across the CC joint in both the Evans and Hintermann specimens. With increasing lateral column length, mean peak CC pressures ranged from 2.9–4.0 and 1.2–2.2 times intact CC pressure for the Evans and Hintermann group, respectively. Normalized mean and normalized peak CC pressures were significantly higher in the Evans osteotomy group compared to the Hintermann group at every level of distraction (see figure). The CC pressures under each testing condition were normalized with respect to the intact foot. Forefoot lateral plantar pressures were significantly increased in specimens corrected with Evans osteotomy at 10 mm and 12 mm of distraction compared to the intact foot. Conclusion: The Evans osteotomy lead to significantly higher CC pressures than the Hintermann osteotomy. This data suggests the Hintermann osteotomy for flatfoot reconstruction minimizes increase in CC joint pressures and could reduce the risk of subsequent CC osteoarthritis.

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The Effect of Lateral Column Lengthening on Subtalar Motion: Are We Trading Deformity for Stiffness?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00045 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0004

Author(s):

Brittany Hedrick ◽

Anthony Riccio ◽

Danielle M. Thomas ◽

Claire Shivers ◽

Matthew Siebert ◽

...

Keyword(s):

Motion Capture ◽

Three Dimensional ◽

Deformity Correction ◽

Porous Titanium ◽

Testing System ◽

Materials Testing ◽

Lateral Column ◽

Fresh Frozen ◽

Lateral Column Lengthening ◽

Paired T Test

Category: Hindfoot; Other Introduction/Purpose: While lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, concern exists as to the effect of this intra- articular osteotomy on subtalar motion. The purpose of this study is to quantify the alterations in subtalar motion following lateral column lengthening (LCL). Methods: The subtalar motion of 14 fresh frozen cadaveric feet was assessed using a three-dimensional motion capture system and materials testing system (MTS). Following potting of the tibia and calcaneus, optic markers were placed into the tibia, calcaneus and talus. The MTS was used to apply a rotational force across the subtalar joint to a torque of 5Nm. Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus was recorded. Specimens then underwent LCL via a calcaneal neck osteotomy which was maintained with a 12mm porous titanium wedge. Repeat subtalar motion analysis was performed and compared to pre-LCL motion using a paired t-test. Results:: No statistically significant differences in subtalar abduction/adduction (10.9O vs. 11.8O degrees, p=.48), supination/pronation (3.5O vs. 2.7O, p=.31), or plantarflexion/dorsiflexion (1.6O vs 1.0O, p=.10) were identified following LCL. Conclusion:: No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. While these findings do not obviate concerns of clinical subtalar stiffness following planovalgus deformity correction, they suggest that diminished postoperative subtalar motion may be due to soft tissue scarring rather than alterations of joint anatomy.

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

Foot & Ankle International ◽

10.1177/1071100717732723 ◽

2017 ◽

Vol 39 (1) ◽

pp. 18-27 ◽

Cited By ~ 16

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.

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