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Double calcaneal osteotomy: realignment considerations in eight patients.
Alan R Catanzariti1, Robert W Mendicino, Glenda L King
1Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA.
Journal of the American Podiatric Medical Association
|January 22, 2005
Summary
This study combined posterior calcaneal displacement and anterior calcaneal distraction osteotomies for treating adolescent flatfoot and adult posterior tibial tendon dysfunction. The combined surgical approach effectively corrects rearfoot valgus and forefoot abduction.
Area of Science:
- Orthopedic surgery
- Foot and ankle reconstruction
- Biomechanical analysis
Background:
- Flexible flatfoot deformity and posterior tibial tendon dysfunction (PTTD) are common conditions affecting foot and ankle alignment.
- Traditional surgical management includes posterior calcaneal displacement osteotomy (PCDO) and anterior calcaneal distraction osteotomy (ACDO).
- Combined application of these osteotomies for adolescent and adult cases requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of a combined surgical technique using posterior calcaneal displacement and anterior calcaneal distraction osteotomies.
- To assess the correction of hindfoot valgus, forefoot abduction, and midtarsal joint instability.
- To analyze the biomechanical effects on the subtalar joint and gait during midstance.
Main Methods:
- Surgical combination of posterior calcaneal displacement osteotomy and anterior calcaneal distraction osteotomy.
- Evaluation of adolescent flatfoot and adult late stage II posterior tibial tendon dysfunction.
- Radiographic assessment including rearfoot alignment, long leg calcaneal axial views, and malleolar valgus indices.
- Clinical assessment of heel alignment, forefoot-rearfoot relationship, and medial column stability.
Main Results:
- Lateral column distraction stabilizes the midtarsal joint, reducing rearfoot valgus and forefoot abduction.
- Posterior calcaneal displacement osteotomy inverts the posterior muscle group, creating a supinatory moment about the subtalar joint.
- Achieved ideal realignment includes a vertical heel, parallel forefoot and rearfoot in the frontal plane, and elimination of forefoot abduction.
Conclusions:
- The combined posterior calcaneal displacement and anterior calcaneal distraction osteotomies offer a viable surgical option for complex flatfoot deformities.
- This technique effectively addresses hindfoot valgus, forefoot abduction, and midtarsal instability.
- The procedure promotes supination during gait by altering the biomechanics of the posterior muscle group and subtalar joint.