A mid-term follow-up of Koutsogiannis’ osteotomy in adult-acquired flatfoot stage II and “early stage III”

Abstract

Introduction: Koutsogiannis’ osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. Methods: We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis’ osteotomy due to adult-acquired flatfoot stage II and “early stage III”: a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. Results: Sixteen cases were “early stage III” and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and “early stage III”. Five cases presented a mild dysesthesia but only one patient needed neurolysis. Conclusions: We consider the Koutsogiannis’ osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and “early stage III” adult-acquired flatfoot.

Minimally Invasive Flat Foot Alingment: A New Method

“…Hindfoot arthritis are the next stage for these patients. Performing the calcaneal medializing correction can avoid this evolution (13,16,19). So, the best time to perform the procedure is after deformity but before arthritis, which means that the patient should be addressed in a lifetime when short recovery procedures are fundamental for early return to work, your understanding is that minimally invasive corrections will play a fundamental role in this new reality.…”

“…Some recent evidence has shown that in many cases, the disease starts as a ligamental insufficiency and the healthy tibialis posterior reacts trying to compensate and in a later pathology moment degenerate. (1,5,8,10) This new understanding led to surgeries to address ligament reconstruction preserving tibialis posterior (1,3,5,6,8) or isolated calcaneal osteotomies to give a better leaver arm for the tendon function (11,12,13). Minimally invasive calcaneal osteotomy is one possible technique for flat foot correction with many possible advantages are earlier weight bearing and earlier consolidation.…”

“…Minimally invasive calcaneal osteotomy is one possible technique for flat foot correction with many possible advantages are earlier weight bearing and earlier consolidation. (11,12,13) Most descriptions about this technique are made with the patient in lateral position with a lateral approach in a similar fashion as open techniques. (11,12,13).…”

“…(11,12,13) Most descriptions about this technique are made with the patient in lateral position with a lateral approach in a similar fashion as open techniques. (11,12,13). This paper describes the minimally invasive technique made by one lateral or medial approach in a ventral position and our initial results.…”