Abstract
Background
Severe flexible flatfoot deformity in children and adolescents is a complex problem. Calcaneal lengthening remains the gold standard for surgical correction at this institution. However, in a minority of patients, inadequate correction of valgus is noted at surgery and a further calcaneal shift osteotomy is done.
Methods
We have conducted a retrospective review of ten patients who received 15 combined minimally invasive calcaneal shift and calcaneal lengthening osteotomies, which were all performed by the senior author. All patients had failed conservative treatment. We describe our technique for double calcaneal osteotomy combining minimally invasive surgery (MIS) for the medial calcaneal shift with traditional open calcaneal lengthening osteotomy for treating children and adolescents with severe flexible flatfoot deformity.
Results
The average shift achieved was 8.07 mm. The average improvement in Meary’s angle was 14.99°. All of them had radiological and clinical union at 12 weeks. None of the patients developed sural nerve injury, wound breakdown, or infection of the MIS incision.
Conclusion
In double calcaneal osteotomies, the MIS calcaneal medial shift technique can be used safely with potentially lower risks of wound complications and sufficient medial shift, compared to conventional open extensive surgery.
Implications
MIS calcaneal shift osteotomy has an advantage over open conventional open technique in cases where the skin is under tension like in combined calcaneal lengthening osteotomy. With experience, the procedure can be faster than an open procedure.
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References
Sullivan AJ (1999) Pediatric flatfoot: evaluation and management. J Am Acad Orthop Surg 7:44–53
Van Aman SE, Schon LC (2006) Subtalar arthroereisis as adjunct treatment for type II posterior tibial tendon deficiency. Tech Foot Ankle Surg 5:117–125
Coughlin MJ, Saltzman CL, Anderson RB (2013) Mann’s surgery of the foot and ankle, 9th ed. Elsevier Saunders, Philadelphia
Pomeroy GC, Manoli A (1997) A new operative approach for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report. Foot Ankle Int 18:206–212
Rathjen KE, Mubarak SJ (1998) Calcaneal-cuboid-cuneiform osteotomy for the correction of valgus foot deformities in children. J Pediatr Orthop 18:775–782
Viegas GV (2003) Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer. J Foot Ankle Surg 42:199–207
Tennant JN, Carmont M, Phisitkul P (2014) Calcaneus osteotomy. Curr Rev Musculoskelet Med 7:271–276. https://doi.org/10.1007/s12178-014-9237-8
McCall RE, Lillich JS, Harris JR, Johnston FA (1985) The Grice extraarticular subtalar arthrodesis: a clinical review. J Pediatr Orthop 5:442–445
Mosca VS (1995) Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg Am 77:500–512
De Pellegrin M, Moharamzadeh D, Strobl WM et al (2014) Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children. J Child Orthop 8:479–487
Schindelin J, Arganda-Carreras I, Frise E et al (2012) Fiji: an open-source platform for biological-image analysis. Nat Methods 9:676–682
Bolt PM, Coy S, Toolan BC (2007) A comparison of lateral column lengthening and medial translational osteotomy of the calcaneus for the reconstruction of adult acquired flatfoot. Foot Ankle Int 28:1115–1123. https://doi.org/10.3113/FAI.2007.1115
DiDomenico LA, Haro AA, Cross DJ (2011) Double calcaneal osteotomy using single, dual-function screw fixation technique. J Foot Ankle Surg 50:773–775
Frankel JP, Turf RM, Kuzmicki LM (1995) Double calcaneal osteotomy in the treatment of posterior tibial tendon dysfunction. J Foot Ankle Surg 34:254–261
Kheir E, Borse V, Sharpe J et al (2015) Medial displacement calcaneal osteotomy using minimally invasive technique. Foot Ankle Int 36:248–252
Kendal AR, Khalid A, Ball T et al (2015) Complications of minimally invasive calcaneal osteotomy versus open osteotomy. Foot Ankle Int 36:685–690
Geng X, Xu J, Ma X et al (2015) Anatomy of the sural nerve with an emphasis on the incision for medial displacement calcaneal osteotomy. J Foot Ankle Surg 54:341–344. https://doi.org/10.1053/j.jfas.2014.07.008
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Mourkus, H., Prem, H. Double calcaneal osteotomy with minimally invasive surgery for the treatment of severe flexible flatfeet. International Orthopaedics (SICOT) 42, 2123–2129 (2018). https://doi.org/10.1007/s00264-018-3910-2
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DOI: https://doi.org/10.1007/s00264-018-3910-2