Medial Soft-Tissue Release for Lateralising Calcaneal Osteotomy: A Cadaveric Study

Lateralising calcaneal osteotomy for pes cavus is generally regarded to be harder to shift than a medialising calcaneal osteotomy for pes planus. The aim of our study was to determine the structures which restrain a lateral shift.

Lateralising calcaneal osteotomy was performed on four soft-embalmed cadavers via a standard lateral approach and the lateral calcaneal shift was measured before and after the release of flexor retinaculum. Further exploratory dissection around the osteotomy site revealed the abductor hallucis muscle to be the main restraint to the lateral shift of the calcaneus. Subsequently, lateralising calcaneal osteotomy was performed on another four cadavers and the abductor hallucis muscle fascia as well as the plantar fascia was released. The lateral shift was measured before and after the fascia release, and compared with the results achieved following the flexor retinaculum release in the first four cadavers.

Lateralising calcaneal osteotomy alone resulted in an average of 4.5-mm lateral shift in the first four cadaveric specimens. Releasing the flexor retinaculum led to a further 3-mm increase of lateral shift on average. In the next four cadaveric specimens, lateralising calcaneal osteotomy alone resulted in an average of 5.5-mm lateral shift. Release of abductor hallucis muscle fascia and the plantar fascia in these four specimens increased the lateral shift by an additional 7 mm on average. Hence, release of abductor hallucis muscle fascia resulted in an extra 4-mm shift on average compared with what is achieved with flexor retinaculum release.

Abductor hallucis muscle fascia was discovered to be one of the main structures limiting the lateral shift in lateralising calcaneal osteotomy. Release of fascia over this muscle as well as the plantar fascia should help in improving lateral shift. Further experimental and clinical research is necessary to confirm the findings of this pilot study.