[Osteotomies in varus malalignment of the ankle]

Joint-preserving osteotomies in patients with symptomatic varus malalignment of the ankle. Osseous procedures together with soft-tissue rebalancing are performed at the level of the distal tibia/fibula or calcaneus. Realignment of the joint line will subsequently reduce intraarticular forces at the ankle and thereby slow down the degenerative process.

Varus malalignment of the ankle with remaining cartilage in the tibiotalar joint.

Severe neurovascular deficiencies. Severe instability of the hindfoot. Severe cartilage lesions of the entire ankle (grade 3-4 according to Outerbridge).

Varus deformities of the distal tibia: medial opening-wedge osteotomy or lateral closing-wedge osteotomy. The lateral closing procedure requires an osteotomy of the fibula. Varus deformity of the hindfoot: valgization by lateral closing- wedge osteotomy of the calcaneus and lateral shift of the calcaneal tuberosity, i.e., Z-shaped osteotomy. Additional procedures at the first metatarsal and softtissue procedures must be considered in all these patients.

Immobilization in a non-weight-bearing cast for 6-8 weeks. Thereafter, increase in weight bearing as tolerated. Physiotherapy for muscular strengthening and restoration of gait pattern.

Twelve patients with an osteotomy of the distal tibia presented with a significant reduction of pain on a visual analog scale (p = 0.0001) and an increased range of motion of 33 degrees (5-55 degrees ) preoperatively compared to 39 degrees (25-50 degrees ) postoperatively. Radiologic assessment also revealed an improvement of preexisting arthritic signs. All 18 patients treated with a Z-shaped calcaneal osteotomy reported pain relief with osseous consolidation after 6 months.