Titrating the Amount of Bony Correction in Progressive Collapsing Foot Deformity

Ellis, Scott J.; Johnson, Jeffrey E.; Day, Jonathan; Deland, Jonathan T.; Hintermann, Beat; Myerson, Mark S.; Schon, Lew C.; Thordarson, David B.; Sangeorzan, Bruce J.

doi:10.1177/1071100720950741

Cited by 21 publications

(10 citation statements)

References 30 publications

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“…Compensatory forefoot supination/varus has been demonstrated in the setting of a planovalgus deformity and often is partially corrected with an opening wedge medial cuneiform osteotomy (Cotton osteotomy). 1,4,7,10,16,18 Furthermore, forefoot driven hindfoot varus in a cavovarus foot may be treated partially with a dorsiflexion M1 osteotomy. 21 Both these approaches correct sagittal plane deformities without appreciation of a potential rotatory abnormality of the first metatarsal.…”

Section: Discussionmentioning

confidence: 99%

Association Between Hindfoot Alignment and First Metatarsal Rotation

et al. 2021

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Background: The association between forefoot and hindfoot position for planus and cavus feet is fundamental to the treatment of these deformities. However, no studies have evaluated the association between hindfoot alignment and first metatarsal (M1) axial rotation. Understanding this possible relationship may help to understand the deformity and improve patient care. The purpose of this study is to determine a correlation between hindfoot alignment and metatarsal rotation as assessed by weightbearing computed tomography (WBCT). Methods: Patients who underwent weightbearing plain radiography (WBPR) and WBCT between 2015 and 2018 were evaluated. Hindfoot alignment was measured with the calcaneal moment arm (CMA). M1 rotation was measured using the Kim and Saltzman angles. Patient subgroups were created according to the severity of valgus/varus hindfoot alignment. Statistical analyses were performed to evaluate for association between variables. Results: Among the 196 patient feet included in the study, the average CMA was 6.0 ± 16.2 mm. The average Kim and Saltzman angles were 7.7 ± 12.9 degrees and 2.8 ± 13.1 degrees, respectively. The average Meary angle was 182.0 ± 11.9 degrees. A moderately strong association was found between the CMA and the Saltzman ( r = 0.641, P < .01) and Kim angles ( r = 0.615, P < .01). Hindfoot valgus was associated with M1 pronation and hindfoot varus with M1 supination. Additionally, inverse relationships between the Meary angle and the Saltzman ( r = −0.600, P < .01) and Kim angles ( r = −0.529, P < .01) were identified. Conclusion: In this well-defined cohort, we found substantial correlation between hindfoot alignment and M1 rotation. Hindfoot valgus was associated with M1 pronation, and hindfoot varus was associated with M1 supination. Surgeons correcting cavovarus/planovalgus deformities should be aware of this association and evaluate the need for first-ray derotation. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Association Between Hindfoot Alignment and First Metatarsal Rotation

et al. 2021

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“…The angle measurement and arch height of the models were similar to those of the PCFD population. 3,9,12,13,25,31,32,39,41,47 The comparison results between the rectangle and triangular grafts suggested that the correcting ability of rectangle grafts was stronger than that of triangular grafts. However, the contact characteristics of the calcaneocuboid joint and talonavicular joint were abnormal, whereas the strain of the spring ligament even increased.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Effects of Graft Shape for the Evans Lateral Column Lengthening Procedure: A Patient-Specific Finite Element Investigation

Hua

2021

Foot Ankle Int.

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Background: The Evans calcaneal lengthening osteotomy procedure is widely used for correcting progressive collapsing foot deformity. However, it can result in overcorrection and degenerations of the calcaneocuboid joint. Different shapes of graft have been used in the Evans calcaneal osteotomy, but potential differences in their biomechanical effects is still unclear. The present study was designed to explore the biomechanical effects of graft shape and improve the Evans procedure to avoid or minimize detrimental effects. Methods: Twelve patient-specific finite element models were established and validated. A triangular or rectangular wedge of varying size was inserted at the lateral edge of calcaneus, and the degree of correction was quantified. The stress in spring ligaments and plantar fascia and the contact characteristics of the talonavicular and calcaneocuboid joints were calculated and compared accordingly. Results: The rectangular graft provided a much higher degree of correction than triangular grafts did. However, the contact characteristics of the calcaneocuboid joint and talonavicular joint were abnormal, with clear sensitivity to increased graft size, and the modeled strain of the spring ligament increased. Conclusion: The finite element analysis predicts that the rectangular grafts provide a higher degree of correction, but risks overcorrection compared with triangular grafts. The triangular graft may have a lower degree of disturbance to the biomechanical behaviors of the midtarsal joint. Clinical Relevance: The model shows that both the shape and size of an Evans osteotomy bone wedge can have effects on the contiguous joints and ligamentous structures. Those effects should be considered when selecting a bone wedge for an Evans calcaneal osteotomy. Level of Evidence: Level III, case-control study.

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“…The goal is to correct the valgus hindfoot into neutral or slightly valgus by distracting the short arm osteotomy about 6 to 8 mm in length with a wedge strut allograft inserted into the gap. 15 The posterior fragment was carefully controlled to ensure good contact with the subtalar part of the osteotomy. Percutaneous Kirschner wires (23 cases) or a 2.7-mm locking plate (3 early cases) was used for fixation.…”

Section: Operative Proceduresmentioning

confidence: 99%

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

et al. 2021

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Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

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Titrating the Amount of Bony Correction in Progressive Collapsing Foot Deformity

Cited by 21 publications

References 30 publications

Association Between Hindfoot Alignment and First Metatarsal Rotation

Association Between Hindfoot Alignment and First Metatarsal Rotation

Biomechanical Effects of Graft Shape for the Evans Lateral Column Lengthening Procedure: A Patient-Specific Finite Element Investigation

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

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