Effect of Calcaneal Lengthening on Relationships among the Hindfoot, Midfoot, and Forefoot

Abstract

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)

Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

“…Further study regarding the long-term effect of calcaneocuboid joint subluxation after calcaneal lengthening is needed. It is known that increased tension in the plantar ligaments and plantar fascia contribute to create the bowstring effect, which restores the medial longitudinal arch [8,16,24]. Despite the relatively high reliability of the calcaneal pitch angle measurement, however, it has been shown to be a less valid method for discriminating hindfoot valgus and varus deformities and for correlating with foot pressure distribution [14].…”

“…A consensus-building session to select and define the radiographic parameters was held by five orthopaedic surgeons (MSP, KML, KHS, SGS, BA), who had orthopaedic experience of 13, 11, 9, 4, and 2 years, respectively. Previous studies were reviewed [3,6,13,[24][25][26][27], and five parameters that were considered to have clinical relevance in quantifying planovalgus foot deformity were selected for the radiographic measurements. Additionally, two indices were developed to evaluate the relative calcaneal length and calcaneocuboid subluxation after calcaneal lengthening osteotomy.…”

Adult Acguired Flatfoot Deformity (Review)

“…это вмешательство обыч-но выполняется по методике D. Evans, который показал, что удлинение наружной боковой ко-лонны стопы путем внедрения костного транс-плантата в область переднего отростка пяточной кости может исправлять абдукцию переднего от-дела и вальгусную деформацию [23]. удлинение пяточной кости, по данным B. Sangeorsan с со-авторами, увеличивает угол покрытия головки таранной кости в таранно-ладьевидном суставе в среднем на 26°, таранно-пяточный угол увели-чивается на 6,4°, а угол наклона пяточной кости возрастает на 10,8° [72].…”

Effect of foot shape on the three-dimensional position of foot bones

“…9,11,12 While some X-ray parameters have good inter-rater reliability, 9,15 large variability between measurements has also been reported. 15 Furthermore, Perry and colleagues consistently underestimated the length of the first metatarsal in dorsal/plantar X rays, thus demonstrating a potential shortcoming of measuring a 3D structure with two-dimensional (2D) X-rays.…”

“…Other researchers have quantified foot shape using X-ray parameters, such as the lateral talometatarsal angle, [7][8][9][10][11][12] the calcaneal pitch angle, [12][13][14] and the talonavicular coverage angle. 9,11,12 While some X-ray parameters have good inter-rater reliability, 9,15 large variability between measurements has also been reported.…”