Fibular Graft: An Alternative Option in Calcaneal Lateral Column Lengthening

Evan opening wedge osteotomy is a gold-standard option for lateral column lengthening in skeletally immature patients. Various types of grafts are used to support lengthening, including autografts, allografts, xenografts and specialised plate systems. Each of them has its advantages and disadvantages. Iliac crest autograft is the most commonly utilised graft with excellent results. However, it has complications related to donor site morbidity and persistent iliac pain. The study aims to display the clinical and radiological outcomes of mid-fibular autograft used for Evans calcaneal lengthening osteotomy in skeletally immature patients with symptomatic flexible pes planovalgus.

This prospective single-centre case series included 29 teenagers who had symptomatic pes planovalgus and were included in the study from January 2018 to July 2024, with an average age of 10.9 years. Thirteen patients (44.8%) were operated on the right side and sixteen patients (55.2%) on the left side. Worth's classification was used to evaluate the incorporation of the graft from the 6th to 8th week.

The graft size taken in the study was 11.9 mm. Full union of the graft was noticed in all patients within 7.2 weeks. Significant improvement was noticed in calcaneal inclination and lateral talus-first metatarsal angle. Significant improvements in the AOFAS ankle-foot scale from 67 preoperatively to 98.2 postoperatively. The graft incorporation was in the third degree in seven patients (24.1%) and the fourth degree in 22 patients (75.9%). Regeneration of the donor site occurred in all cases within 10 months.

Fibular autograft demonstrated satisfactory clinical and radiographic outcomes with successful graft incorporation in this cohort. These findings suggest that fibular autograft is a feasible option for Evans calcaneal lengthening osteotomy.