Medial displacement osteotomy with an additional procedure for acquired flatfoot deformity based on posterior tibial tendon dysfunction: patient group evaluation
Abstract
Introduction: The article is intended to provide an overview of adult acquired flatfoot deformity through its basic pathomorphological signs. Furthermore, the authors asses their group of patients, who have undergone a surgical treatment of flatfoot deformity.
Material and Methods: There were 19 patients involved in the study aged from 32 to 67 years. According to the Raikin's classification of acquired flatfoot, they fit into the IIa subtype.
Medial displacement osteotomy of the calcaneus to correct its hypervalgosity represented an essential part of the surgical treatment. This procedure was followed by an additional surgery of the medial pillar or the Achilles tendon complex.
Three radiographic signs were used for retrospective evaluation in the study. The Meary angle deviation, valgus deviation in Saltzman view for axial calcaneal alignment and percental talo-navicular coverage in frontal plane.
These parameters were measured for assessment preoperatively and 6-8 months postoperatively. Results: Evaluating correction ability for calcaneus malalignment was our primary outcome for a clinical practice.
There were 17 out of 19 patients with successful correction. In addition, we recorded healing complications in 3 patients.
A revision procedure was necessary in one case. Discussion: Locking step plate or compressing screws are 2 most common way how to fix medial displacement osteotomy.
Both procedures have its own advantages and disadvantages. Hindfoot malalignment could also be corrected by another procedure - sinus tarsi implant, lateral column lengthening, Z type osteotomy or a triple arthrodesis, which is a final procedure for hindfoot correction.
Though, calcaneal osteotomy is barely used as a single surgery, as it needs to be followed by a variol medial column corrections in surgical flatfoot management.