Double calcaneal osteotomy with minimally invasive surgery for the treatment of severe flexible flatfeet

Original Paper
  • 14 Downloads

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.

Keywords

Calcaneal lengthening Calcaneal osteotomy Calcaneal osteotomies Minimal invasive surgery Flatfoot deformity Flexible flatfoot 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

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

References

  1. 1.
    Sullivan AJ (1999) Pediatric flatfoot: evaluation and management. J Am Acad Orthop Surg 7:44–53CrossRefPubMedGoogle Scholar
  2. 2.
    Van Aman SE, Schon LC (2006) Subtalar arthroereisis as adjunct treatment for type II posterior tibial tendon deficiency. Tech Foot Ankle Surg 5:117–125CrossRefGoogle Scholar
  3. 3.
    Coughlin MJ, Saltzman CL, Anderson RB (2013) Mann’s surgery of the foot and ankle, 9th ed. Elsevier Saunders, PhiladelphiaGoogle Scholar
  4. 4.
    Pomeroy GC, Manoli A (1997) A new operative approach for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report. Foot Ankle Int 18:206–212CrossRefPubMedGoogle Scholar
  5. 5.
    Rathjen KE, Mubarak SJ (1998) Calcaneal-cuboid-cuneiform osteotomy for the correction of valgus foot deformities in children. J Pediatr Orthop 18:775–782PubMedGoogle Scholar
  6. 6.
    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 42:199–207CrossRefPubMedGoogle Scholar
  7. 7.
    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 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    McCall RE, Lillich JS, Harris JR, Johnston FA (1985) The Grice extraarticular subtalar arthrodesis: a clinical review. J Pediatr Orthop 5:442–445CrossRefPubMedGoogle Scholar
  9. 9.
    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 77:500–512CrossRefPubMedGoogle Scholar
  10. 10.
    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 8:479–487CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schindelin J, Arganda-Carreras I, Frise E et al (2012) Fiji: an open-source platform for biological-image analysis. Nat Methods 9:676–682CrossRefPubMedGoogle Scholar
  12. 12.
    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 CrossRefPubMedGoogle Scholar
  13. 13.
    DiDomenico LA, Haro AA, Cross DJ (2011) Double calcaneal osteotomy using single, dual-function screw fixation technique. J Foot Ankle Surg 50:773–775CrossRefPubMedGoogle Scholar
  14. 14.
    Frankel JP, Turf RM, Kuzmicki LM (1995) Double calcaneal osteotomy in the treatment of posterior tibial tendon dysfunction. J Foot Ankle Surg 34:254–261CrossRefPubMedGoogle Scholar
  15. 15.
    Kheir E, Borse V, Sharpe J et al (2015) Medial displacement calcaneal osteotomy using minimally invasive technique. Foot Ankle Int 36:248–252CrossRefPubMedGoogle Scholar
  16. 16.
    Kendal AR, Khalid A, Ball T et al (2015) Complications of minimally invasive calcaneal osteotomy versus open osteotomy. Foot Ankle Int 36:685–690CrossRefPubMedGoogle Scholar
  17. 17.
    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 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.University Hospitals of North Midlands NHS TrustStoke-on-TrentUK
  2. 2.The Royal Orthopaedic Hospital NHS Foundation TrustBirminghamUK

Personalised recommendations