A retrospective analysis of anterior calcaneal osteotomy with allogenic bone graft.

Anterior calcaneal osteotomy (ACO) with extension bone graft is commonly employed in the treatment of symptomatic supple, hypermobile flatfoot in adolescent as well as adult (>or= 18 years of age) patients. Although autogenous bone graft has been considered the gold standard, allogenic bone is widely used for this procedure because it is readily available, requires no additional procedure for procurement and has incorporation rates similar to autogenous bone graft. There is increasing agreement among surgeons that the union rates with allograft bone are comparable with that observed with autograft bone when used in the ACO. We reviewed the medical records of 51 consecutive patients who had undergone 53 ACO with allogenic bone graft for the repair of flatfoot deformity in an effort to further evaluate outcomes associated with the use of allogenic bone graft. All of the patients had at least 12 months of follow-up. The mean time to graft incorporation was 9.10 +/- 1.54 weeks for adolescents and 9.81 +/- 2.13 weeks for adults (P = .0149), The incidence of graft incorporation (bone union) was 100% and 90% (P = .1391) in the adolescent and adult groups, respectively. Complications included lateral column pain, sinus tarsitis, nonunion, calcaneocuboid capsulitis, complex regional pain syndrome, incisional dehiscence, and sural neuritis; and all of the complications occurred in the adult group. The results support the understanding that ACO with allogenic bone graft is a reasonable alternative to autograft bone graft in the treatment of flexible flatfoot in adolescent and adult patients.

The effect of hindfoot realignment in triple arthrodesis.

UNLABELLED: Triple arthrodesis is a useful form of surgical intervention for repair of advanced hindfoot deformity. Crucial to the success of triple arthrodesis is achievement of a suitable alignment of the hindfoot in relation to the leg and forefoot. A number of radiographic measurements can be used to describe the resultant alignment of the foot and, in this article, we present the results of a review of a series of 28 triple arthrodeses, in 24 patients, followed for a median duration of 19 (range 12 to 38) months. The results of this investigation showed clinically and statistically significant improvements in the anteroposterior talocalcaneal angle and talo-first metatarsal angles, and the lateral talo-first metatarsal angle; and triple arthrodesis realigned the hindfoot primarily by means of transverse plane movement of the talus over the calcaneus, and sagittal plane realignment occurred primarily by means of reduction of the downward pitch of the talus rather than by means of elevation of the pitch of the calcaneus. Only 1 (1.19% of fusion sites, 3.57% of cases, 4.17% of patients) symptomatic nonunion was observed. Correlation analyses showed that a normal (35 degrees to 50 degrees ) preoperative lateral talocalcaneal angle was moderately inversely correlated, and a normal (< or = 21 degrees ) preoperative lateral talar declination angle was strongly positively correlated, with none to mild postoperative pain. Based on these findings, we concluded that triple arthrodesis satisfactorily realigned the hindfoot and reduced pain in patients with advanced arthrosis. LEVEL OF CLINICAL EVIDENCE: 4.

Cavus foot reconstruction in 3 patients with Charcot-Marie-Tooth disease.

UNLABELLED: Charcot-Marie-Tooth (CMT) is a progressive genetic disorder that produces motor and sensory neuropathy that affects the legs, feet, and hands. A dorsally based closing wedge midfoot osteotomy at the apex of the cavus foot deformity combined with soft tissue and other osseous procedures are procedures performed for CMT patients at The Western Pennsylvania Hospital. The focus of this article is to present a prospective evaluation of 3 patients using radiographic assessment, static biomechanical and the malleolar valgus index (MVI), dynamic alignment, and function results using the F-scan. These results demonstrate that patients have improved function with a plantigrade foot and decreased pain. The Short Form McGill Pain Questionnaire (SF-MPQ) showed that there was a decrease in pain. There was a decrease in the MVI and improved function comparing the preoperative and postoperative F-scan in all patients. The midfoot osteotomy addresses the apex of the progressive cavus foot deformity and provides a plantigrade foot in 3 CMT patients. LEVEL OF CLINICAL EVIDENCE: 4.

Calcaneal osteotomies for the treatment of adult-acquired flatfoot.

Calcaneal osteotomies are useful procedures for the treatment of stage 2 adult-acquired flatfoot. Often combined with adjunctive soft-tissue procedures, the posterior calcaneal displacement osteotomy and Evans procedure provide effective realignment of pes planovalgus deformity. Preoperative evaluation, indications, contraindications, surgical considerations and techniques are discussed.