Abstract
In this study, clinical and radiological results after lateral column lengthening
by calcaneocuboid distraction arthrodesis and calcaneus osteotomy were compared. Thirty-three
patients (35 feet) treated with lateral column lengthening by distraction arthrodesis
(14 patients, 16 feet; group I) or by calcaneus osteotomy (19 patients, 19 feet; group
II) for adult-acquired flatfoot deformity caused by stage II posterior tibial tendon
dysfunction were compared retrospectively. Mean follow-up was 42.4 months (range,
6-78 months) for group I and 15.8 months (range, 6-32 months) for group II (P < .001).
The American Orthopaedic Foot & Ankle Society ankle-hindfoot score was determined,
4 variables were measured on preoperative and postoperative weight-bearing radiographs,
and a number of independent and outcome variables, including patient satisfaction,
were recorded. Group 2 had a significantly higher American Orthopaedic Foot & Ankle
Society score compared with group I (mean, 85 vs. 72, respectively; P < .02) at time
of last follow-up, and there were no dissatisfied patients in group I, whereas 2 patients
in group II were dissatisfied with the result of the operation. All radiological results
were significantly better at time of follow-up in both groups (except for talocalcaneal
angle in group I), although no significant differences were noted in the amount of
change in radiographic measurements between the groups. No significant correlation
was found between follow-up time and radiographic improvement, indicating stable radiographic
measurements over time. In group II, 13 mild calcaneocuboid subluxations were observed.
In both groups, 1 nonunion and 1 wound complication occurred. Based on our experience
with the patients described in this report, we recommend lateral column lengthening
by means of calcaneus osteotomy rather than distraction arthrodesis of the calcaneocuboid
joint, for correction of stage II posterior tibial tendon dysfunction.
Level of Clinical Evidence
Keywords
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References
- Adult acquired flatfoot deformity.J Bone Joint Surg. 1996; 78-A: 780-792
- Non-surgical management for tibialis posterior insufficiency.Foot Ankle Surg. 2002; 8: 197-201
- Surgical treatment of severe deformity resulting from posterior tibial tendon dysfunction.Foot Ankle Int. 2001; 22: 944-949
- In situ tibialis posterior to flexor digitorum longus tendon transfer for tibialis posterior tendon dysfunction: a simplified surgical approach with outcome of 11 patients.J Foot Ankle Surg. 2001; 40: 2-7
- Rupture of the posterior tibial tendon causing flatfoot.J Bone Joint Surg. 1985; 67-A: 556-561
- Treatment of mobile flat foot by displacement osteotomy of the calcaneus.J Bone Joint Surg. 1971; 53-B: 96-100
- Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency: a radiological investigation.Foot Ankle Int. 1995; 16: 712-718
- Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus transfer and calcaneal osteotomy.Foot Ankle Int. 2004; 25: 445-450
- Treatment of stage II posterior tibial tendon dysfunction with flexor hallucis longus transfer and medial displacement calcaneal osteotomy.Foot Ankle Int. 2001; 22: 305-312
- Talonavicular arthrodesis for the painful adult acquired flatfoot.Foot Ankle Int. 1996; 17: 658-661
- A comparison of lateral column lengthening and medial translational osteotomy of the calcaneus for the reconstruction of adult acquired flatfoot.Foot Ankle Int. 2007; 28: 1115-1123
- The lateral column lengthening and medial column stabilization procedures.Clin Orthop Relat Res. 1999; 365: 81-90
- Calcaneo-valgus deformity.J Bone Joint Surg. 1975; 57-B: 270-278
- Calcaneal-cuboid distraction arthrodesis combined with medial soft tissue reconstruction for posterior tibial tendon dysfunction stage II.Foot Ankle Surg. 2003; 9: 157-160
- Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon.Foot Ankle Int. 1999; 20: 622-629
- Adult acquired flexible flatfoot, treated by calcaneocuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening.Acta Orthop. 2006; 77: 156-163
- Preliminary results comparing two methods of lateral column lengthening.Foot Ankle Int. 2001; 22: 107-119
- Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot.J Bone Joint Surg. 1999; 81-A: 1545-1560
- Lateral column lengthening with calcaneocuboid fusion: range of motion in the triple joint complex.Foot Ankle Int. 1995; 16: 729-733
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- A review of radiographic lines and angles used in orthopedics.Am J Orthop. 1995; 24: 590-601
- Effect of calcaneal lengthening on relationships among the hindfoot, midfoot, and forefoot.Foot Ankle. 1993; 14: 136-141
- Results of non-surgical treatment of stage II posterior tibial tendon dysfunction: a 7- to 10-year follow up.Foot Ankle Int. 2008; 29: 781-786
Moseir-LaClair S, Pomeroy G, Manoli II A. Intermediate follow-up on the double osteotomy and tendon transfer for stage II posterior tibial tendon insufficiency. Foot Ankle Int 22:283-291, 2001.
- A new treatment for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report.Foot Ankle Int. 1997; 18: 206-212
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
