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

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Anatomy
• Surgical Biomechanics

Background:

• Lateralizing calcaneal osteotomy for pes cavus is technically challenging.
• Identifying structures limiting calcaneal shift is essential for surgical planning.

Purpose of the Study:

• To determine the specific anatomical structures that restrain lateral shift during lateralizing calcaneal osteotomy.
• To evaluate the impact of releasing these structures on the degree of calcaneal shift.

Main Methods:

• Performed lateralizing calcaneal osteotomy on cadavers.
• Measured lateral calcaneal shift before and after releasing the flexor retinaculum.
• Conducted further dissections to identify restraints, focusing on the abductor hallucis muscle and plantar fascia.
• Compared shift achieved with flexor retinaculum release versus abductor hallucis and plantar fascia release.

Main Results:

• Lateralizing calcaneal osteotomy alone yielded an average shift of 4.5-5.5 mm.
• Releasing the flexor retinaculum increased shift by an average of 3 mm.
• Releasing abductor hallucis muscle fascia and plantar fascia increased shift by an average of 7 mm.
• Abductor hallucis fascia release provided a greater increase in shift (4 mm) compared to flexor retinaculum release.

Conclusions:

• The abductor hallucis muscle fascia is a primary restraint to lateral shift in lateralizing calcaneal osteotomy.
• Releasing the abductor hallucis muscle fascia and plantar fascia can enhance the lateral shift achieved during surgery.
• Further research is needed to validate these findings clinically.