Incidence of Plantar Lateral Foot Pain before and after the Use of Trial Metal Wedges in Lateral Column Lengthening

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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Effect of Calcaneal Osteotomy and Lateral Column Lengthening on the Plantar Fascia: A Biomechanical Investigation

Foot & Ankle International ◽

10.1177/107110079801900605 ◽

1998 ◽

Vol 19 (6) ◽

pp. 370-373 ◽

Cited By ~ 48

Author(s):

Greg A. Horton ◽

Mark S. Myerson ◽

Brent G. Parks ◽

Yong-Wook Park

Keyword(s):

Plantar Fascia ◽

Lateral Column ◽

Calcaneal Osteotomy ◽

Biomechanical Investigation ◽

Lateral Column Lengthening

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

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2006.11.004 ◽

2007 ◽

Vol 22 (4) ◽

pp. 472-477 ◽

Cited By ~ 28

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

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Lateral Column Lengthening

Essential Foot and Ankle Surgical Techniques ◽

10.1007/978-3-030-14778-5_19 ◽

2019 ◽

pp. 189-196

Author(s):

Kyle S. Peterson ◽

David Larson ◽

Roberto A. Brandão

Keyword(s):

Lateral Column ◽

Lateral Column Lengthening

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Lateral Column Lengthening with Calcaneocuboid Fusion: Range of Motion in the Triple Joint Complex

Foot & Ankle International ◽

10.1177/107110079501601111 ◽

1995 ◽

Vol 16 (11) ◽

pp. 729-733 ◽

Cited By ~ 75

Author(s):

Jonathan T. Deland ◽

James C. Otis ◽

Kyung-Tai Lee ◽

Sharon M. Kenneally

Keyword(s):

Range Of Motion ◽

Subtalar Joint ◽

Clinical Investigation ◽

Three Dimensions ◽

Lateral Column ◽

Joint Range Of Motion ◽

Lateral Column Lengthening ◽

Joint Range

Lengthening the lateral column of the foot has been shown to correct flatfoot deformity. In adults, however, lengthening leads to calcaneocuboid arthritis. Lateral column lengthening with calcaneocuboid fusion, which lengthens the lateral column of the foot and prevents calcaneocuboid arthritis, was investigated in a cadaver model to determine the remaining range of motion in the talonavicular and subtalar joints. Inversion/eversion motion was produced by tendon pulls and the range of motion was measured in three dimensions using a magnetic space tracker. After lateral column lengthening with calcaneocuboid fusion, 48% of talonavicular and 70% of subtalar joint range of motion were preserved. Analysis of the inversion and eversion ranges of motion suggests that the lengthening fusion limits eversion more than inversion. These findings demonstrate the need for clinical investigation of this procedure, which could preserve motion in the talonavicular and subtalar joints, correct deformity, and obviate calcaneocuboid arthritis.

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Effect of Calcaneal Lengthening on Relationships among the Hindfoot, Midfoot, and Forefoot

Foot & Ankle ◽

10.1177/107110079301400305 ◽

1993 ◽

Vol 14 (3) ◽

pp. 136-141 ◽

Cited By ~ 304

Author(s):

Bruce J. Sangeorzan ◽

Vincent Mosca ◽

Sigvard T. Hansen

Keyword(s):

Pitch Angle ◽

Articular Surface ◽

Angular Measurement ◽

Pes Planus ◽

Lateral Column ◽

Medial Side ◽

Significant Correction ◽

Before And After ◽

Calcaneal Lengthening ◽

The Relationship

To better understand the bony component of pes planus and the means by which the Evans calcaneal lengthening corrects them, we studied the standing radiographs of seven adult patients who had undergone calcaneal lengthening to treat symptomatic pes planus. Weightbearing AP and lateral views done preoperatively and postoperatively were used for the study. For each set of films, the following parameters were measured: on the lateral view; overall length of the calcaneus, lateral talometatarsal angle, lateral talocalcaneal angle, and the calcaneal pitch angle; and on the dorsoplanar view, the talometatarsal and talocalcaneal angle. In addition, the relative coverage of the talus by the navicular was described by an angular measurement based on the relationship of the center of the talus to the center of the navicular. The average improvements in lateral talocalcaneal angle (a reflection of hind-foot valgus) was 6.4° when the long axis of the calcaneus was used and 6.8° when the inferior surface of the calcaneus was used for the measurement. The lateral talometatarsal angle improved an average 11.3° (from an average of 19.7° to 8.4°). The dorsoplantar talometatarsal angle (a measure of forefoot adduction/abduction) improved 15.8° (preoperative average 26.8°, postoperative average 11°). The calcaneal pitch angle improved an average 10.8° (preoperative average 3.2°, postoperative average 14°). The relationship between the talus and navicular was defined by an angular measurement based on the center of each articular surface before and after correction using this measurement. An average improvement of 26° occurred in the alignment of these two articular surfaces. This study confirms Evans' belief that significant correction can be obtained by lateral column lengthening, that the relationship between navicular and talus can be restored without fusion, and that the forefoot position corrects without operative intervention to the medial side of the foot. This study also provides numerical guidelines for the surgeon planning surgical correction of symptomatic pes planus, and since bony relationships can be observed before and after correction, some insight may be gained into tarsal morphology of pes planus.

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

BMJ Case Reports ◽

10.1136/bcr-2021-243761 ◽

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.

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