SLR - July 2012 - Dyane E. Tower
Reference: Basioni, Y., El-Ganainy, A-R., El-Hawary, A. (2011). Double Calcaneal Osteotomy and Percutaneous Tenoplasty for Adequate Arch Restoration in Adult Flexible Flat Foot. International Orthopaedics, 35, 47-51
Scientific Literature Review
Reviewed by: Dyane E. Tower, DPM
Residency Program: North Colorado Podiatric Surgical Residency
Podiatric Relevance:
To obtain structural correction of a flexible flatfoot, triple arthrodesis has been considered the standard of care. However, in patients with symptoms of flexible flatfoot, ranging from medial arch collapse to impingement pain laterally, who do not have radiographic evidence of articular involvement could do well with a combination of calcaneal osteotomies and Achilles tendon lengthening. With peri-articular osteotomies, joint function is maintained while structural alignment is addressed.
Methods:
Over a two year period, 14 male patients (17 feet) were prospectively enrolled and treated for symptomatic flexible flatfoot with double calcaneal osteotomy and percutaneous Achilles tendon lengthening. Calcaneal inclination angle, talocalcaneal and talo-first metatarsal angles were measured on AP and lateral radiographs pre- and postoperatively. Load distribution with a footprint was also obtained before and after surgery. Surgical intervention was performed when pain, instability and severe functional limitations were present after conservative treatment options failed. Evans and posterior calcaneal displacement osteotomies were performed through a single lateral incision and fixated with percutaneous K-wires. Percutaneous Achilles tendon lengthening was also performed. Patients were placed in a posterior splint for six weeks with K-wires removed at three weeks postoperatively.
Results:
Talocalcaneal and talo-first-metatarsal angles improved significantly from pre- to postoperatively on both AP and lateral radiographs, as did the mean AOFAS score from 48.4 to 78.6. A more normal load distribution was noted on the postoperative footprints. Failure of graft incorporation occurred in one patient, who subsequently underwent revision surgery. Undercorrection and sural neuritis each occurred in two out of 17 patients.
Conclusions:
Combining percutaneous Achilles tendon lengthening with double calcaneal osteotomies for the correction of flexible flatfoot, without radiographic evidence of arthritis, had good results in this study with an average follow-up of 22 months. Improvement was not only noted with measurement of radiographic angles, but also with the AOFAS score.