Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity

Saunders, Stuart M; Ellis, Scott J.; Demetracopoulos, Constantine A.; Marinescu, Anca; Burkett, Jayme; Deland, Jonathan T.

doi:10.1177/1071100717732723

Cited by 27 publications

(29 citation statements)

References 27 publications

(44 reference statements)

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“…The existing literature shows that increased pressure on the CC joint is a well-documented complication after E-LLCOT, even if a standard graft size is used. 7,8,20 In addition, we detected 1 (5.8%) case of subluxation of the CC joint following E-LLCOT, which is reported to be a major risk factor for E-LLCOT and can also lead to CC-arthritis. 5,6,14,22,23 There was no subluxation of the CC joint after H-LLCOT.…”

Section: Discussionmentioning

confidence: 71%

Outcomes of Evans Versus Hintermann Calcaneal Lengthening Osteotomy for Flexible Flatfoot

et al. 2019

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Background: Evans (E) and Hintermann (H) lateral lengthening calcaneal osteotomies (LLCOTs) are commonly used to correct flexible flatfoot deformities. Both methods are well accepted and produce good clinical results. The aim of this study was to compare the postoperative outcomes of both osteotomies. Methods: We retrospectively examined 53 patients with flatfoot deformities, who received surgery between October 2008 and March 2014. Seventeen E-LLCOT and 36 H-LLCOT procedures were performed during this time period, with a mean follow-up of 67.7 ± 20.6 and 40 ± 12.9 months, respectively. Data were collected using clinical and radiological examination, as well as clinical scores (Foot and Ankle Outcome Score [FAOS], University of California at Los Angeles [UCLA] activity score, numerical rating scale [NRS], and the Short-Form 36-item Health Survey [SF-36]) during regular follow-up. Results: For both groups of patients, the FAOS score, pain-NRS, and SF-36 improved significantly following surgery ( P < .05). The talus–second metatarsal angle, talonavicular coverage, and naviculocuneiform overlap showed significant correction ( P < .05). Postoperatively, radiographic degenerative changes were detected in the calcaneocuboid (CC) and subtalar joint in both groups of patients: 41% and 18% after E-LLCOT compared with 25% and 14% after H-LLCOT, although these changes did not have any clinical relevance ( P < .05). No secondary arthrodesis was necessary. There were no significant differences in the clinical or radiological outcome parameters when compared between the 2 groups. Conclusion: Both surgical techniques resulted in a significant improvement of clinical outcome scores and led to good radiological correction of flatfoot deformities. It appears that the CC joint develops less degenerative changes following the H-LLCOT procedure. Level of Evidence: Level III, comparative series.

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Section: Discussionmentioning

confidence: 71%

Outcomes of Evans Versus Hintermann Calcaneal Lengthening Osteotomy for Flexible Flatfoot

et al. 2019

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“…34,116 Preliminary work has shown that patients who undergo this osteotomy have excellent healing and correction with few of the complications inherent to traditional LCL, although there is a risk of peroneal tendon injury due to the proximal osteotomy. 34,104…”

Section: Forefoot Abductionmentioning

confidence: 99%

Adult-Acquired Flatfoot Deformity

Henry

Shakked

Ellis

2019

Foot & Ankle Orthopaedics

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148

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Adult-acquired flatfoot deformity (AAFD) comprises a wide spectrum of ligament and tendon failure that may result in significant deformity and disability. It is often associated with posterior tibial tendon deficiency (PTTD), which has been linked to multiple demographic factors, medical comorbidities, and genetic processes. AAFD is classified using stages I through IV. Nonoperative treatment modalities should always be attempted first and often provide resolution in stages I and II. Stage II, consisting of a wide range of flexible deformities, is typically treated operatively with a combination of soft tissue procedures and osteotomies. Stage III, which is characterized by a rigid flatfoot, typically warrants triple arthrodesis. Stage IV, where the flatfoot deformity involves the ankle joint, is treated with ankle arthrodesis or ankle arthroplasty with or without deltoid ligament reconstruction along with procedures to restore alignment of the foot. There is limited evidence as to the optimal procedure; thus, the surgical indications and techniques continue to be researched.

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“…12,24,27 Because LCL is a powerful procedure in correcting abduction and there is a risk for overcorrection, studies have cited a TN uncoverage of greater than 40% as an indication for LCL. 9,24 Previous work has also derived a linear equation relating the change in lateral incongruency angle (LIA) with the amount of LCL correction, 3 which allows for preoperative planning and titration of operative correction. 6 Proper titration and correction are integral to the success of the procedure as multiple studies have shown that overcorrection (adduction of the TN joint) is associated with inferior patient-reported outcomes in addition to lateral column overload, increased risk for stress fractures of the fifth metatarsal, increased lateral plantar pressure, and pain.…”

Section: Rationalementioning

confidence: 99%

Titrating the Amount of Bony Correction in Progressive Collapsing Foot Deformity

et al. 2020

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Recommendation: There is evidence indicating that the amount of bony correction performed in the setting of progressive collapsing foot deformity reconstructive surgery can be titrated within a recommended range for a variety of procedures. The typical range when performing a medial displacement calcaneal osteotomy should be 7 to 15 mm of medialization of the tuberosity. The typical range when performing an Evans lateral column lengthening should be 5 to 10 mm of a laterally based wedge in the anterior calcaneus. The typical range when performing a plantarflexion opening wedge osteotomy of the medial cuneiform (Cotton) osteotomy should be 5 to 10 mm of a dorsal wedge. Level of Evidence: Level V, consensus, expert opinion.

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Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity

Abstract: Level III, retrospective cohort study.

Cited by 27 publications

References 27 publications

Outcomes of Evans Versus Hintermann Calcaneal Lengthening Osteotomy for Flexible Flatfoot

Outcomes of Evans Versus Hintermann Calcaneal Lengthening Osteotomy for Flexible Flatfoot

Adult-Acquired Flatfoot Deformity

Titrating the Amount of Bony Correction in Progressive Collapsing Foot Deformity

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