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Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity.
Foot Ankle Int. 2013 Jun; 34(6):781-91.FA

Abstract

BACKGROUND

Multiple procedures have been described to treat stage II (flexible) deformities driven by the clinical presence of "mild" versus "severe" deformity. The purpose of this study was to identify the radiographic correction after bony realignment procedures and to compare preoperative measures with postoperative measures to better understand the clinical application of these procedures.

METHODS

Seventy-two feet in 68 patients treated for stage II deformity between January 1999 and December 2010 were available for retrospective chart review. The average age of the patients was 55 years, and final radiographs were evaluated at an average of 9 months postoperatively. All patients had a flexor digitorum longus transfer to the navicular and bony realignment. Radiographic parameters measured included lateral talus-first metatarsal angle, medial cuneiform-floor distance, calcaneal pitch, anteroposterior talus-second metatarsal angle, and talonavicular coverage angle. Differences in pre- and postoperative measurements and between group comparisons were analyzed.

RESULTS

Three patient groups were identified: medial displacement calcaneal osteotomy (group 1), lateral column lengthening (group 2), and both medial displacement calcaneal osteotomy and lateral column lengthening (group 3). The lateral talus-first metatarsal angle mean difference was 5.1 degrees in group 1, 16.2 degrees in group 2, and 16.5 degrees in group 3. The talonavicular coverage angle mean difference was 5.7 degrees in group 1, 24.2 degrees in group 2, and 19.4 degrees in group 3. Changes in pre- to postoperative measures were statistically significant for all groups for the parameters measured. The pairwise group comparison revealed a statistically significant difference in the correction obtained in group 3 compared with that of group 1.

CONCLUSION

Clinical and radiographic parameters are a consideration when choosing bony realignment procedures to reconstruct a flexible flatfoot deformity. In the treatment of more severe deformities, lateral column lengthening resulted in a greater radiographic improvement in alignment. A medial displacement osteotomy alone is also a valuable tool to correct these deformities although it provided a different level of correction compared with the lateral column lengthening.

LEVEL OF EVIDENCE

Level III, comparative case series.

Authors+Show Affiliations

Aurora Advanced Healthcare, Milwaukee, WI, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23386748

Citation

Iossi, Michael, et al. "Short-term Radiographic Analysis of Operative Correction of Adult Acquired Flatfoot Deformity." Foot & Ankle International, vol. 34, no. 6, 2013, pp. 781-91.
Iossi M, Johnson JE, McCormick JJ, et al. Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity. Foot Ankle Int. 2013;34(6):781-91.
Iossi, M., Johnson, J. E., McCormick, J. J., & Klein, S. E. (2013). Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity. Foot & Ankle International, 34(6), 781-91. https://doi.org/10.1177/1071100713475432
Iossi M, et al. Short-term Radiographic Analysis of Operative Correction of Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2013;34(6):781-91. PubMed PMID: 23386748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity. AU - Iossi,Michael, AU - Johnson,Jeffrey E, AU - McCormick,Jeremy J, AU - Klein,Sandra E, Y1 - 2013/02/05/ PY - 2013/2/7/entrez PY - 2013/2/7/pubmed PY - 2013/8/28/medline KW - flatfoot deformity KW - measurement KW - radiographic KW - tibialis posterior tendon SP - 781 EP - 91 JF - Foot & ankle international JO - Foot Ankle Int VL - 34 IS - 6 N2 - BACKGROUND: Multiple procedures have been described to treat stage II (flexible) deformities driven by the clinical presence of "mild" versus "severe" deformity. The purpose of this study was to identify the radiographic correction after bony realignment procedures and to compare preoperative measures with postoperative measures to better understand the clinical application of these procedures. METHODS: Seventy-two feet in 68 patients treated for stage II deformity between January 1999 and December 2010 were available for retrospective chart review. The average age of the patients was 55 years, and final radiographs were evaluated at an average of 9 months postoperatively. All patients had a flexor digitorum longus transfer to the navicular and bony realignment. Radiographic parameters measured included lateral talus-first metatarsal angle, medial cuneiform-floor distance, calcaneal pitch, anteroposterior talus-second metatarsal angle, and talonavicular coverage angle. Differences in pre- and postoperative measurements and between group comparisons were analyzed. RESULTS: Three patient groups were identified: medial displacement calcaneal osteotomy (group 1), lateral column lengthening (group 2), and both medial displacement calcaneal osteotomy and lateral column lengthening (group 3). The lateral talus-first metatarsal angle mean difference was 5.1 degrees in group 1, 16.2 degrees in group 2, and 16.5 degrees in group 3. The talonavicular coverage angle mean difference was 5.7 degrees in group 1, 24.2 degrees in group 2, and 19.4 degrees in group 3. Changes in pre- to postoperative measures were statistically significant for all groups for the parameters measured. The pairwise group comparison revealed a statistically significant difference in the correction obtained in group 3 compared with that of group 1. CONCLUSION: Clinical and radiographic parameters are a consideration when choosing bony realignment procedures to reconstruct a flexible flatfoot deformity. In the treatment of more severe deformities, lateral column lengthening resulted in a greater radiographic improvement in alignment. A medial displacement osteotomy alone is also a valuable tool to correct these deformities although it provided a different level of correction compared with the lateral column lengthening. LEVEL OF EVIDENCE: Level III, comparative case series. SN - 1071-1007 UR - https://www.unboundmedicine.com/medline/citation/23386748/Short_term_radiographic_analysis_of_operative_correction_of_adult_acquired_flatfoot_deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100713475432?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -