Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지

Calcaneal Lengthening Osteotomy for the Symptomatic Flexible Flatfoot in Adults

성인의 유연성 편평족에 대한 종골 연장술

  • Choi, Hong Joon (Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Cho, Jae Ho (Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Wang, Bae Gun (Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University College of Medicine)
  • 최홍준 (인제대학교 의과대학 해운대백병원 정형외과) ;
  • 조재호 (인제대학교 의과대학 서울백병원 정형외과) ;
  • 왕배건 (인제대학교 의과대학 서울백병원 정형외과)
  • Received : 2013.04.13
  • Accepted : 2013.05.21
  • Published : 2013.06.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Calcaneal lengthening osteotomy is one option for the treatment of symptomatic flexible flatfoot in adults. The aim of the study was to evaluate the short term clinical and radiologic results and analyze its complications. Materials and Methods: Twelve feet who had undergone calcaneal lengthening osteotomy without flexor digitorum longus transfer between December 2009 and July 2011 were included. The mean age was 40.6 years (23~75 years). The mean followup was 17.3 months (13~25 months). Clinical outcome were assessed using American Orthopadics Foot ans Ankle Society (AOFAS) score and visual analogue scale (VAS) for pain. Four radiologic parameters were measured from weightbearing radiographs to evaluate the difference between preoperatively and postoperatively measures. To analyze the complications, calcaneocuboid joint subluxation and degenerative change were measured postoperatively. Results: The mean AOFAS score improved from 55.3 points preoperatively to 82.2 points at lastest follow-up (p=0.000). The mean VAS improved from 6.3 points preoperatively to 3.2 points postoperatively (p=0.002).All radiologic parameters, the mean talonavicular coverage angle on AP view, the mean talo-1st metatarsal angle on AP and lateral view and the mean calcaneal pitch angle, significantly improved after calcaneal lengthening osteotomy. Nine feets (75%) were shown the degenerative change in the calcaneocuboid joint at latest follow-up radiographs. Conclusion: Calcaneal lengthening osteotomy for the symptomatic flexible flatfoot in adults produced significant improvement in clinical and radiologic parameters, but calcaneocuboid joint osteoarthritis occurred postoperatively remained a major problem.

Keywords

References

  1. JH Park JM, WC Lee, WH Bae, JG Seo. Short-term Results of Medial Displacement Calcaneal Osteotomy for Flexible Flatfoot. J Korean Foot Ankle Soc. 2009;13:113-7.
  2. Zaw H, Calder JD. Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review. Knee Surg Sports Traumatol Arthrosc. 2010;18:135-42. https://doi.org/10.1007/s00167-009-1015-6
  3. Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br. 1975;57:270-8.
  4. Hintermann B, Valderrabano V, Kundert HP. Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int. 1999;20:622-9. https://doi.org/10.1177/107110079902001002
  5. Richter M, Zech S. Lengthening osteotomy of the calcaneus and flexor digitorum longus tendon transfer in flexible flatfoot deformity improves talo-1st metatarsal-Index, clinical outcome and pedographic parameter. Foot Ankle Surg. 2013;19:56-61. https://doi.org/10.1016/j.fas.2012.10.006
  6. Thomas RL, Wells BC, Garrison RL, Prada SA. Preliminary results comparing two methods of lateral column lengthening. Foot Ankle Int. 2001;22:107-19. https://doi.org/10.1177/107110070102200205
  7. Feldman NJ, Oloff LM, Schulhofer SD. In situ tibialis posterior to flexor digitorum longus tendon transfer for tibialis posterior tendon dysfunction: a simplified surgical approach with outcome of 11 patients. J Foot Ankle Surg. 2001;40:2-7. https://doi.org/10.1016/S1067-2516(01)80034-X
  8. Younger AS, Sawatzky B, Dryden P. Radiographic assessment of adult flatfoot. Foot Ankle Int. 2005;26:820-5. https://doi.org/10.1177/107110070502601006
  9. Thomas JL, Kunkel MW, Lopez R, Sparks D. Radiographic values of the adult foot in a standardized population. J Foot Ankle Surg. 2006;45:3-12. https://doi.org/10.1053/j.jfas.2005.10.014
  10. Adams SB, Jr., Simpson AW, Pugh LI, Stasikelis PJ. Calcaneocuboid joint subluxation after calcaneal lengthening for planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop. 2009;29:170-4. https://doi.org/10.1097/BPO.0b013e3181982c33
  11. Kellgren JH, Lawrence JS, Bier F. Genetic Factors in Generalized Osteo-Arthrosis. Ann Rheum Dis. 1963;22:237-55. https://doi.org/10.1136/ard.22.4.237
  12. Dinucci KR, Christensen JC, Dinucci KA. Biomechanical consequences of lateral column lengthening of the calcaneus: Part I. Long plantar ligament strain. J Foot Ankle Surg. 2004;43:10-5. https://doi.org/10.1053/j.jfas.2003.11.013
  13. Thordarson DB, Hedman T, Lundquist D, Reisch R. Effect of calcaneal osteotomy and plantar fasciotomy on arch configuration in a flatfoot model. Foot Ankle Int. 1998;19: 374-8. https://doi.org/10.1177/107110079801900606
  14. Toolan BC, Sangeorzan BJ, Hansen ST, Jr. Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults. J Bone Joint Surg Am. 1999;81:1545-60. https://doi.org/10.2106/00004623-199911000-00006
  15. Mosier-LaClair S, Pomeroy G, Manoli A, 2nd. Operative treatment of the difficult stage 2 adult acquired flatfoot deformity. Foot Ankle Clin. 2001;6:95-119. https://doi.org/10.1016/S1083-7515(03)00083-4
  16. Mann RA, Thompson FM. Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg Am. 1985;67:556-61. https://doi.org/10.2106/00004623-198567040-00009
  17. Cooper PS, Nowak MD, Shaer J. Calcaneocuboid joint pressures with lateral column lengthening (Evans) procedure. Foot Ankle Int. 1997;18:199-205. https://doi.org/10.1177/107110079701800403
  18. Momberger N, Morgan JM, Bachus KN, West JR. Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model. Foot Ankle Int. 2000;21:730-5. https://doi.org/10.1177/107110070002100903
  19. Phillips GE. A review of elongation of os calcis for flat feet. J Bone Joint Surg Br. 1983;65:15-8.