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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 dorsoplantar 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 hindfoot valgus) was 6.4 degrees when the long axis of the calcaneus was used and 6.8 degrees when the inferior surface of the calcaneous was used for the measurement. The lateral talometatarsal angle improved an average 11.3 degrees (from an average of 19.7 degrees to 8.4 degrees). The dorsoplantar talometatarsal angle (a measure of forefoot adduction/abduction) improved 15.8 degrees (preoperative average 26.8 degrees, postoperative average 11 degrees). The calcaneal pitch angle improved an average 10.8 degrees (preoperative average 3.2 degrees, postoperative average 14 degrees). 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 degrees occurred in the alignment of these two articular surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)

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A modified Lapidus procedure was introduced at Harborview Medical Center in 1979 for the treatment of symptomatic hallux valgus with hypermobile first ray. The results of the procedures were reviewed retrospectively in 32 patients with 40 feet that were operated on between 1979 and 1984. Preoperative diagnosis was symptomatic hallux valgus complex with hypermobile first ray in 33 and failed bunion surgery in 7. Follow-up ranged from 30 months to 6 1/2 years. Union of the arthrodesis site occurred in 36 (90%). The average preoperative intrametatarsal angle was 14 degrees (range 7.5 to 20 degrees) and the hallux valgus angle was 26 degrees (range 0 to 50 degrees). At healing, the angles were as follows: intermetatarsal angle 6 degrees (range 0 to 18 degrees) and hallux valgus angle 11 degrees (range -3 to 30 degrees). The average change in the length of the first metatarsal was -5 mm for those without bone graft and +4 mm for those with bone graft. Of 33 feet operated on as a primary procedure, successful results were reported in 75% by our rating system. Of 7 feet operated on for failed previous surgery, all were improved. Best results were obtained in those with multiple screw fixation, use of bone graft, and attention to plantarflexion of the first metatarsal.