Preliminary results comparing two methods of lateral column lengthening.

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction
• Podiatric Medicine

Background:

• Painful pes planus (flatfoot) significantly impacts quality of life.
• Lateral column lengthening is a surgical approach to correct this deformity.

Purpose of the Study:

• To compare the radiographic and clinical outcomes of Evans opening wedge osteotomy versus calcaneocuboid distraction arthrodesis for painful flatfoot.
• To evaluate patient satisfaction and complication rates associated with these procedures.

Main Methods:

• Retrospective review of 25 patients (27 feet) undergoing lateral column lengthening.
• Procedures included Evans osteotomy (10 feet) or calcaneocuboid fusion (17 feet), with concomitant posterior tibial tendon debridement and flexor digitorum longus transfer.
• Radiographic and American Orthopaedic Foot & Ankle Society (AOFAS) scores were assessed at least one year postoperatively.

Main Results:

• Both surgical techniques demonstrated significant radiographic improvement.
• Calcaneocuboid fusion showed slightly greater radiographic improvement, but not statistically significant compared to Evans osteotomy.
• Patient satisfaction was high (83.5% very satisfied), with 96% willing to undergo the surgery again. AOFAS scores averaged 87.9 (osteotomy) and 80.9 (fusion), with no significant difference.
• Overall complication rate was 34 feet; nonunion/delayed union was a notable issue with calcaneocuboid arthrodesis.

Conclusions:

• Both Evans opening wedge calcaneal osteotomy and calcaneocuboid distraction arthrodesis provide significant improvements for painful, flexible flatfoot.
• High complication rates persist for both techniques.
• Nonunion and delayed union present significant challenges specifically for the calcaneocuboid distraction arthrodesis method.