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Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer.
J Bone Joint Surg Am. 2006 Aug; 88(8):1726-34.JB

Abstract

BACKGROUND

Acquired flexible flatfoot encompasses a wide spectrum of disease, and there is no validated treatment protocol. We hypothesized that a medializing calcaneal osteotomy with a flexor digitorum longus transfer is adequate to correct a less severe acquired flexible flatfoot but not a more severe flatfoot. We also hypothesized that use of an additional procedure would further correct the flatfoot.

METHODS

The study included seven pairs of cadaver specimens, with one side randomly selected for the creation of a mild flatfoot deformity and the other, for the creation of a severe flatfoot deformity. Cyclic axial load was applied to the intact foot, to the flatfoot, after correction with a medializing calcaneal osteotomy and a flexor digitorum longus transfer, and after the addition of a subtalar arthroereisis. Radiographic and pedobarographic data were obtained at each stage. A repeated-measures analysis of variance with post hoc analysis was used to compare all parameters in the intact foot with those in the flatfoot and corrected specimens. A Student t test was used to compare flatfoot severity between the mild and severe models.

RESULTS

Compared with the intact foot, the mild and severe flatfoot models showed a significant change in the talar-first metatarsal angle (p = 0.01 and 0.03, respectively), talonavicular angle (p = 0.04 and 0.04), and medial cuneiform height (p = 0.03 and 0.05). The mild and severe models were significantly different from each other with regard to the talar-first metatarsal angle (p = 0.003) and talonavicular angle (p = 0.002). After the osteotomy and tendon transfer in the mild-flatfoot model, the talar-first metatarsal angle and talonavicular angle were not significantly different from those in the intact state. In the severe-flatfoot model, the talar-first metatarsal angle, talonavicular angle, and medial cuneiform height remained significantly undercorrected after the osteotomy and tendon transfer. After the arthroereisis, the talonavicular angle and medial cuneiform height were not significantly different from the values for the intact foot.

CONCLUSIONS

In a cadaver model, the effectiveness of different procedures on radiographic and pedobarographic parameters varies with the severity of an acquired flatfoot deformity.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, MD 21218, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16882894

Citation

Vora, Anand M., et al. "Correction of Moderate and Severe Acquired Flexible Flatfoot With Medializing Calcaneal Osteotomy and Flexor Digitorum Longus Transfer." The Journal of Bone and Joint Surgery. American Volume, vol. 88, no. 8, 2006, pp. 1726-34.
Vora AM, Tien TR, Parks BG, et al. Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. J Bone Joint Surg Am. 2006;88(8):1726-34.
Vora, A. M., Tien, T. R., Parks, B. G., & Schon, L. C. (2006). Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. The Journal of Bone and Joint Surgery. American Volume, 88(8), 1726-34.
Vora AM, et al. Correction of Moderate and Severe Acquired Flexible Flatfoot With Medializing Calcaneal Osteotomy and Flexor Digitorum Longus Transfer. J Bone Joint Surg Am. 2006;88(8):1726-34. PubMed PMID: 16882894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. AU - Vora,Anand M, AU - Tien,Tudor R, AU - Parks,Brent G, AU - Schon,Lew C, PY - 2006/8/3/pubmed PY - 2006/9/30/medline PY - 2006/8/3/entrez SP - 1726 EP - 34 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 88 IS - 8 N2 - BACKGROUND: Acquired flexible flatfoot encompasses a wide spectrum of disease, and there is no validated treatment protocol. We hypothesized that a medializing calcaneal osteotomy with a flexor digitorum longus transfer is adequate to correct a less severe acquired flexible flatfoot but not a more severe flatfoot. We also hypothesized that use of an additional procedure would further correct the flatfoot. METHODS: The study included seven pairs of cadaver specimens, with one side randomly selected for the creation of a mild flatfoot deformity and the other, for the creation of a severe flatfoot deformity. Cyclic axial load was applied to the intact foot, to the flatfoot, after correction with a medializing calcaneal osteotomy and a flexor digitorum longus transfer, and after the addition of a subtalar arthroereisis. Radiographic and pedobarographic data were obtained at each stage. A repeated-measures analysis of variance with post hoc analysis was used to compare all parameters in the intact foot with those in the flatfoot and corrected specimens. A Student t test was used to compare flatfoot severity between the mild and severe models. RESULTS: Compared with the intact foot, the mild and severe flatfoot models showed a significant change in the talar-first metatarsal angle (p = 0.01 and 0.03, respectively), talonavicular angle (p = 0.04 and 0.04), and medial cuneiform height (p = 0.03 and 0.05). The mild and severe models were significantly different from each other with regard to the talar-first metatarsal angle (p = 0.003) and talonavicular angle (p = 0.002). After the osteotomy and tendon transfer in the mild-flatfoot model, the talar-first metatarsal angle and talonavicular angle were not significantly different from those in the intact state. In the severe-flatfoot model, the talar-first metatarsal angle, talonavicular angle, and medial cuneiform height remained significantly undercorrected after the osteotomy and tendon transfer. After the arthroereisis, the talonavicular angle and medial cuneiform height were not significantly different from the values for the intact foot. CONCLUSIONS: In a cadaver model, the effectiveness of different procedures on radiographic and pedobarographic parameters varies with the severity of an acquired flatfoot deformity. SN - 0021-9355 UR - https://www.unboundmedicine.com/medline/citation/16882894/Correction_of_moderate_and_severe_acquired_flexible_flatfoot_with_medializing_calcaneal_osteotomy_and_flexor_digitorum_longus_transfer_ L2 - http://dx.doi.org/10.2106/JBJS.E.00045 DB - PRIME DP - Unbound Medicine ER -