Tags

Type your tag names separated by a space and hit enter

The contribution of the medial calcaneal osteotomy to the correction of flatfoot deformities.
Foot Ankle Int. 2001 Apr; 22(4):278-82.FA

Abstract

HYPOTHESES/PURPOSE

The success of the medial displacement calcaneal osteotomy in correcting flatfoot deformities is likely to be the result of a shift of the Achilles tendon forces on the hindfoot. The purpose of this study was twofold: 1) to define the contribution of the Achilles tendon to the flatfoot deformity, and 2) to define the effect of a calcaneal medial displacement osteotomy.

METHODS

We used six different experimental dynamic stages: 1) intact foot without Achilles loading; 2) intact foot with Achilles loading; 3) flatfoot without medial calcaneal displacement osteotomy and without Achilles loading; 4) flatfoot without medial calcaneal displacement osteotomy but with Achilles loading; 5) flatfoot with medial calcaneal displacement osteotomy but without Achilles loading; and 6) flatfoot with medial calcaneal displacement osteotomy and with Achilles loading. The experimental flaffoot was developed by releasing the posterior tibial tendon, spring ligament, and plantar fascia and applying 7,000 cycles of axial fatigue load (range, 700 to 1,400 N; 1-Hz frequency). To simulate the phase of midstance, the peroneus longus, peroneus brevis, flexor digitorum longus, and flexor hallucis longus tendons were grasped by clamps, connected to pneumatic actuators, and loaded with precalculated forces. Anteroposterior and lateral radiographs were obtained for each stage on which the following measurements were made: talonavicular coverage angle, talar-first metatarsal angle, talocalcaneal angle, and height of the medial cuneiform. These measurements were compared with a one-way ANOVA.

RESULTS

Between stages 1 and 2, all measurements were statistically insignificant. Between stages 3 and 4, for all measurements, Achilles tendon loading aggravated the flatfoot deformity (p < 0.05). After medial calcaneal osteotomy (stages 5 and 6), the Achilles tendon contributed less to the arch-flattening. We found that the medial displacement osteotomy plays an important role in reducing and/or delaying the progress of flatfoot deformity.

CONCLUSIONS/SIGNIFICANCE

In the flatfoot, loading of the Achilles tendon increases the deformity. Medial calcaneal osteotomy significantly decreases the arch-flattening effect of this tendon and therefore limits the potential increase of the deformity.

Authors+Show Affiliations

Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, MD, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11354439

Citation

Nyska, M, et al. "The Contribution of the Medial Calcaneal Osteotomy to the Correction of Flatfoot Deformities." Foot & Ankle International, vol. 22, no. 4, 2001, pp. 278-82.
Nyska M, Parks BG, Chu IT, et al. The contribution of the medial calcaneal osteotomy to the correction of flatfoot deformities. Foot Ankle Int. 2001;22(4):278-82.
Nyska, M., Parks, B. G., Chu, I. T., & Myerson, M. S. (2001). The contribution of the medial calcaneal osteotomy to the correction of flatfoot deformities. Foot & Ankle International, 22(4), 278-82.
Nyska M, et al. The Contribution of the Medial Calcaneal Osteotomy to the Correction of Flatfoot Deformities. Foot Ankle Int. 2001;22(4):278-82. PubMed PMID: 11354439.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The contribution of the medial calcaneal osteotomy to the correction of flatfoot deformities. AU - Nyska,M, AU - Parks,B G, AU - Chu,I T, AU - Myerson,M S, PY - 2001/5/17/pubmed PY - 2001/8/17/medline PY - 2001/5/17/entrez SP - 278 EP - 82 JF - Foot & ankle international JO - Foot Ankle Int VL - 22 IS - 4 N2 - HYPOTHESES/PURPOSE: The success of the medial displacement calcaneal osteotomy in correcting flatfoot deformities is likely to be the result of a shift of the Achilles tendon forces on the hindfoot. The purpose of this study was twofold: 1) to define the contribution of the Achilles tendon to the flatfoot deformity, and 2) to define the effect of a calcaneal medial displacement osteotomy. METHODS: We used six different experimental dynamic stages: 1) intact foot without Achilles loading; 2) intact foot with Achilles loading; 3) flatfoot without medial calcaneal displacement osteotomy and without Achilles loading; 4) flatfoot without medial calcaneal displacement osteotomy but with Achilles loading; 5) flatfoot with medial calcaneal displacement osteotomy but without Achilles loading; and 6) flatfoot with medial calcaneal displacement osteotomy and with Achilles loading. The experimental flaffoot was developed by releasing the posterior tibial tendon, spring ligament, and plantar fascia and applying 7,000 cycles of axial fatigue load (range, 700 to 1,400 N; 1-Hz frequency). To simulate the phase of midstance, the peroneus longus, peroneus brevis, flexor digitorum longus, and flexor hallucis longus tendons were grasped by clamps, connected to pneumatic actuators, and loaded with precalculated forces. Anteroposterior and lateral radiographs were obtained for each stage on which the following measurements were made: talonavicular coverage angle, talar-first metatarsal angle, talocalcaneal angle, and height of the medial cuneiform. These measurements were compared with a one-way ANOVA. RESULTS: Between stages 1 and 2, all measurements were statistically insignificant. Between stages 3 and 4, for all measurements, Achilles tendon loading aggravated the flatfoot deformity (p < 0.05). After medial calcaneal osteotomy (stages 5 and 6), the Achilles tendon contributed less to the arch-flattening. We found that the medial displacement osteotomy plays an important role in reducing and/or delaying the progress of flatfoot deformity. CONCLUSIONS/SIGNIFICANCE: In the flatfoot, loading of the Achilles tendon increases the deformity. Medial calcaneal osteotomy significantly decreases the arch-flattening effect of this tendon and therefore limits the potential increase of the deformity. SN - 1071-1007 UR - https://www.unboundmedicine.com/medline/citation/11354439/The_contribution_of_the_medial_calcaneal_osteotomy_to_the_correction_of_flatfoot_deformities_ L2 - http://journals.sagepub.com/doi/full/10.1177/107110070102200402?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -