Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

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Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02888-3 ◽

2021 ◽

Author(s):

Gabriele Colo’ ◽

Mattia Alessio Mazzola ◽

Giulio Pilone ◽

Giacomo Dagnino ◽

Lamberto Felli

Keyword(s):

Range Of Motion ◽

Case Series ◽

Deformity Correction ◽

Tibialis Posterior ◽

Open Wedge ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

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New Radiographic Parameters Assessing Forefoot Abduction in the Adult Acquired Flatfoot Deformity

Foot & Ankle International ◽

10.3113/fai.2009.1168 ◽

2009 ◽

Vol 30 (12) ◽

pp. 1168-1176 ◽

Cited By ~ 52

Author(s):

Scott J. Ellis ◽

Joseph C. Yu ◽

Benjamin R. Williams ◽

Cheol Lee ◽

Ya-lin Chiu ◽

...

Keyword(s):

Radiographic Parameters ◽

Adult Acquired Flatfoot Deformity

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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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Effects of Posterior Tibial Tendon Augmented With Biografts and Calcaneal Osteotomy in Stage II Adult-Acquired Flatfoot Deformity

Foot & Ankle Specialist ◽

10.1177/1938640008331032 ◽

2009 ◽

Vol 2 (1) ◽

pp. 27-31 ◽

Cited By ~ 2

Author(s):

Daniel Lee

Keyword(s):

Stage Ii ◽

Posterior Tibial Tendon ◽

Posterior Tibial ◽

Calcaneal Osteotomy ◽

Adult Acquired Flatfoot Deformity

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

Foot & Ankle International ◽

10.1177/10711007211051359 ◽

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.

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