Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer

Abstract

Purpose

Medial displacement calcaneal osteotomy with flexor digitorum longus transfer is a common treatment for the management of the adult flatfoot associated with posterior tibial tendon dysfunction. In the literature, there is a paucity of information regarding the ability of patients to return to sport and recreational activities after this surgical procedure. The purpose of this retrospective clinical study was to assess the rate and type of athletic activities that patients participated in before and after medial displacement calcaneal osteotomy with flexor digitorum longus transfer.

Methods

A consecutive series of 42 patients with a mean age at surgery of 41 years (range 19–74 years) was evaluated with a minimum follow-up of 24 months (range 18–31 months). Pre- and post-operative sporting activities were assessed. At final follow-up, patients were asked to complete a Sports Athlete Foot and Ankle Score (SAFAS). Each patient was also evaluated with weight-bearing radiographs of the foot before surgery and at final follow-up.

Results

Preoperatively, 27 of 42 (64.3 %) patients were engaged in athletic activities, participating in an average of 1.4 h/week (range 0–6 h/week); post-operatively, 36/42 (85.7 %) participated in sport and recreational activities for an average of 3.5 h/week (range 0–15 h/week). Meary’s angle improved significantly from 11.5 ± 6.2 degrees preoperatively to 7.0 ± 5.7 degrees at final follow-up (p < 0.01); calcaneal pitch improved significantly from 16.5 ± 4.6 degrees to 19.0 ± 5.0 degrees (p < 0.01). At final follow-up, patients demonstrated good SAFASs in symptom tolerance (86.4 %), pain tolerance (89.0 %), daily living performance (96.1 %), and sports performance (86.7 %).

Conclusion

The majority of patients returned to sports and recreational activity after medial displacement calcaneal osteotomy and flexor digitorum longus for the treatment of adult flatfoot associated with posterior tibial tendon dysfunction.

Level of evidence

III.

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Fig. 1

Abbreviations

MDCO:

Medial displacement calcaneal osteotomy

FDL:

Flexor digitorum longus

AOFAS:

American Orthopaedic Foot and Ankle Society

SAFAS:

Sports Athlete Foot and Ankle Score

BMI:

Body mass index

MRI:

Magnetic resonance imaging

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Correspondence to F. G. Usuelli.

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All procedures performed in studies involving human participants were in acordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Usuelli, F.G., Di Silvestri, C.A., D’Ambrosi, R. et al. Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer. Knee Surg Sports Traumatol Arthrosc 26, 892–896 (2018). https://doi.org/10.1007/s00167-016-4360-2

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Keywords

  • Posterior tibialis tendon dysfunction
  • Medial displacement calcaneal osteotomy
  • Tendon transfer
  • Return to sport
  • Flatfoot
  • Meary angle
  • Calcaneal pitch