Lateralizing Calcaneal Osteotomies and Their Effect on Calcaneal Alignment: A Three-Dimensional Digital Model Analysis

Cody, Elizabeth; Kraszewski, Andrew P.; Conti, Matthew S.; Ellis, Scott J.

doi:10.1177/1071100718768225

Cited by 17 publications

(8 citation statements)

References 18 publications

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“…Finally, many calcaneal osteotomies require concomitant procedures [ 13 , 14 ], as can be seen in our series, where 91% of patients underwent some ancillary procedure (Broström, ankle arthroscopy, gastrocnemius lengthening, etc.) in the same surgical episode.…”

Section: Discussionmentioning

confidence: 76%

“…The general principle guiding this technique is that the more anterior the osteotomy is performed, the more the calcaneal tuberosity can be mobilized. However, the sural nerve, the medial plantar branch, and the lateral plantar branch are at high risk if the osteotomy is performed more anteriorly [ 3 , 7 , 14 , 15 ]. Kraus et al reported that lateral translation provides greater correction of varus deformity, although it may cause significant additional shortening of the calcaneus [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Neurological Injuries after Calcaneal Osteotomies Are Underdiagnosed

González-Martín

Herrera-Pérez

Ojeda-Jiménez

et al. 2021

JCM

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The incidence of peripheral neurological injuries related to calcaneal osteotomies reported in the literature is low and often described as occasional. The main objective of this study is to determine the incidence of neurological injuries after calcaneal osteotomies and identify which nerve structures are most affected. This retrospective work included 69 patients. Medical records, surgical protocols, and radiographs were analyzed. All patients were summoned to perform current functional tests (EFAS score and SF-12), and a thorough physical examination was performed systematically and bilaterally. The total incidence of neurological injuries was 43.5% (30/69). The percentage of neurapraxias (transient injuries) was 8.7%, while 34.8% of patients presented neurological sequelae (permanent injuries). The most injured nerve or branch was, in decreasing order: sural nerve, medial plantar branch, lateral plantar branch and medial calcaneal branch. Following the so-called “safe zone” clearly decreases the incidence of sural nerve injury (p = 0.035). No significant differences were found between osteotomy site, number of screws, and type of closure and increased neurological injuries. No significant differences were found in the functional tests between the different techniques, nor between patients who presented neurological injuries and those who did not. Neurological injuries after calcaneal osteotomies are underdiagnosed and the incidence is higher than previously reported (43.5%). Such injuries mostly go unnoticed and have no implications in the functional results and patients’ satisfaction.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Neurological Injuries after Calcaneal Osteotomies Are Underdiagnosed

González-Martín

Herrera-Pérez

Ojeda-Jiménez

et al. 2021

JCM

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“…3 Lateralization of the calcaneus also transforms the gastrocnemius and soleus muscles from a deforming varus force to a correcting valgus force on the hindfoot. 5 We had unanimity that an osteotomy is often, but not always, needed in CMT foot reconstruction. There are numerous techniques for a calcaneal osteotomy.…”

Section: Calcaneal Osteotomymentioning

confidence: 99%

A Consensus Statement on the Surgical Treatment of Charcot-Marie-Tooth Disease

et al. 2020

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Background: Charcot-Marie-Tooth (CMT) disease is a hereditary motor-sensory neuropathy that is often associated with a cavovarus foot deformity. Limited evidence exists for the orthopedic management of these patients. Our goal was to develop consensus guidelines based upon the clinical experiences and practices of an expert group of foot and ankle surgeons. Methods: Thirteen experienced, board-certified orthopedic foot and ankle surgeons and a neurologist specializing in CMT disease convened at a 1-day meeting. The group discussed clinical and surgical considerations based upon existing literature and individual experience. After extensive debate, conclusion statements were deemed “consensus” if 85% of the group were in agreement and “unanimous” if 100% were in support. Conclusions: The group defined consensus terminology, agreed upon standardized templates for history and physical examination, and recommended a comprehensive approach to surgery. Early in the course of the disease, an orthopedic foot and ankle surgeon should be part of the care team. This consensus statement by a team of experienced orthopedic foot and ankle surgeons provides a comprehensive approach to the management of CMT cavovarus deformity. Level of Evidence: Level V, expert opinion.

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“…On the other hand, few reports have discussed the possibility of peri-operative neurovascular compromise, despite this being a known complication [4]. Nerve injuries can occur during the approach [6,7], as a result of the osteotomy itself [4,6] or due to acquired iatrogenic tarsal tunnel syndrome [4,8], amongst others. Lateral structures, such as the sural nerve and lateral calcaneal nerve, are at risk during exposure in the lateral approach to the calcaneus [7,9], while the posterior tibial nerve and its calcaneal, medial plantar, and lateral plantar branches are at risk during osteotomy and medial or lateral displacement [9].…”

Section: Introductionmentioning

confidence: 99%

“Safe incision” in calcaneal sliding osteotomies reduces the incidence of sural nerve injury

González-Martín

Herrera-Pérez

Ojeda-Jiménez

et al. 2021

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to demonstrate whether application of the so-called safe incision when performing calcaneal sliding osteotomies reduces the risk of sural nerve injury. Methods Patients who underwent either medial or lateral sliding calcaneal osteotomies between 2010 and 2018 were analysed retrospectively. A thorough neurological examination was performed, and the location of the surgical wound and the type of wound closure were recorded. The European Foot and Ankle Surgery (EFAS) score and 12-item Short Form Survey (SF-12) were also documented. Results A total of 57 patients were included, of which 20 (35.1%) had a sural nerve injury. Five patients had a neurapraxia (8.8%), while 15 patients had a permanent injury (26.3%). Respecting the "safe incision" decreased sural nerve injury (p = 0.02). The type of osteotomy and closure was not significant. No significant differences were found in the functional tests between the different techniques, or between patients who presented sural nerve injury and those who did not. Conclusion Sural nerve injury after calcaneal sliding osteotomies is higher than previously reported in the scientific literature, with an incidence of 35.1% (20/57 patients). Respecting the so-called safe zone (oblique incision that runs through the point that is > 1/3 of the distance from the tip of the lateral malleolus to the posteroinferior margin of the calcaneus) clearly decreases the incidence of sural nerve injury. Finally, the majority of patients remained asymptomatic despite the neurological injury.

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Lateralizing Calcaneal Osteotomies and Their Effect on Calcaneal Alignment: A Three-Dimensional Digital Model Analysis

Abstract: For the surgical treatment of cavovarus foot deformities, osteotomies with wedge resection in addition to lateralization enable more powerful correction.

Cited by 17 publications

References 18 publications

Neurological Injuries after Calcaneal Osteotomies Are Underdiagnosed

Neurological Injuries after Calcaneal Osteotomies Are Underdiagnosed

A Consensus Statement on the Surgical Treatment of Charcot-Marie-Tooth Disease

“Safe incision” in calcaneal sliding osteotomies reduces the incidence of sural nerve injury

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