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The contribution of medializing calcaneal osteotomy on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity.
Foot Ankle Int. 2013 Feb; 34(2):159-66.FA

Abstract

BACKGROUND

Successful correction of hindfoot alignment in adult acquired flatfoot deformity (AAFD) is likely influenced by the degree of medializing calcaneal osteotomy (MCO) performed, but it is not known if other reconstruction procedures significantly contribute as well. The purpose of this study was to evaluate the correlation between common preoperative and postoperative variables and hindfoot alignment.

METHODS

Thirty patients with stage II AAFD undergoing flatfoot reconstruction were followed prospectively. Preoperative and postoperative radiographs were reviewed to assess for correction in hindfoot alignment as measured by the change in hindfoot moment arm. Nineteen variables were analyzed, including age, gender, height, weight, body mass index (BMI), medial cuneiform-fifth metatarsal height, anteroposterior (AP) talonavicular coverage, AP talus-first metatarsal, lateral talus-first metatarsal and calcaneal pitch angles as well as intraoperative use of the MCO, lateral column lengthening (LCL), Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament reconstruction, and gastrocnemius recession or Achilles lengthening. Mean age was 57.3 years (range, 22-77). Final radiographs were obtained at a mean of 47 weeks (range, 25-78) postoperatively.

RESULTS

Seven variables were found to significantly affect hindfoot moment arm. These were gender (P < .05), the amount of MCO performed (P < .001), LCL (P < .01), first tarsometatarsal fusion (P < .01), spring ligament reconstruction (P < .01), medial cuneiform-fifth metatarsal height (P < .001), and calcaneal pitch angle (P < .05). Multivariate regression analysis revealed that MCO was the only significant predictor of hindfoot moment arm. The final regression model for MCO showed a good fit (R(2) = .93, P < .001).

CONCLUSION

Correction of hindfoot valgus alignment obtained in flatfoot reconstruction is primarily determined by the MCO procedure and can be modeled linearly. We believe that the hindfoot alignment view can serve as a valuable preoperative measurement to help surgeons adjust the proper amount of correction intraoperatively.

LEVEL OF EVIDENCE

Level IV, prospective case series.

Authors+Show Affiliations

Hospital for Special Surgery, New York, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23413053

Citation

Chan, Jeremy Y., et al. "The Contribution of Medializing Calcaneal Osteotomy On Hindfoot Alignment in the Reconstruction of the Stage II Adult Acquired Flatfoot Deformity." Foot & Ankle International, vol. 34, no. 2, 2013, pp. 159-66.
Chan JY, Williams BR, Nair P, et al. The contribution of medializing calcaneal osteotomy on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity. Foot Ankle Int. 2013;34(2):159-66.
Chan, J. Y., Williams, B. R., Nair, P., Young, E., Sofka, C., Deland, J. T., & Ellis, S. J. (2013). The contribution of medializing calcaneal osteotomy on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity. Foot & Ankle International, 34(2), 159-66. https://doi.org/10.1177/1071100712460225
Chan JY, et al. The Contribution of Medializing Calcaneal Osteotomy On Hindfoot Alignment in the Reconstruction of the Stage II Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2013;34(2):159-66. PubMed PMID: 23413053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The contribution of medializing calcaneal osteotomy on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity. AU - Chan,Jeremy Y, AU - Williams,Benjamin R, AU - Nair,Pallavi, AU - Young,Elizabeth, AU - Sofka,Carolyn, AU - Deland,Jonathan T, AU - Ellis,Scott J, Y1 - 2013/01/10/ PY - 2013/2/16/entrez PY - 2013/2/16/pubmed PY - 2013/4/10/medline SP - 159 EP - 66 JF - Foot & ankle international JO - Foot Ankle Int VL - 34 IS - 2 N2 - BACKGROUND: Successful correction of hindfoot alignment in adult acquired flatfoot deformity (AAFD) is likely influenced by the degree of medializing calcaneal osteotomy (MCO) performed, but it is not known if other reconstruction procedures significantly contribute as well. The purpose of this study was to evaluate the correlation between common preoperative and postoperative variables and hindfoot alignment. METHODS: Thirty patients with stage II AAFD undergoing flatfoot reconstruction were followed prospectively. Preoperative and postoperative radiographs were reviewed to assess for correction in hindfoot alignment as measured by the change in hindfoot moment arm. Nineteen variables were analyzed, including age, gender, height, weight, body mass index (BMI), medial cuneiform-fifth metatarsal height, anteroposterior (AP) talonavicular coverage, AP talus-first metatarsal, lateral talus-first metatarsal and calcaneal pitch angles as well as intraoperative use of the MCO, lateral column lengthening (LCL), Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament reconstruction, and gastrocnemius recession or Achilles lengthening. Mean age was 57.3 years (range, 22-77). Final radiographs were obtained at a mean of 47 weeks (range, 25-78) postoperatively. RESULTS: Seven variables were found to significantly affect hindfoot moment arm. These were gender (P < .05), the amount of MCO performed (P < .001), LCL (P < .01), first tarsometatarsal fusion (P < .01), spring ligament reconstruction (P < .01), medial cuneiform-fifth metatarsal height (P < .001), and calcaneal pitch angle (P < .05). Multivariate regression analysis revealed that MCO was the only significant predictor of hindfoot moment arm. The final regression model for MCO showed a good fit (R(2) = .93, P < .001). CONCLUSION: Correction of hindfoot valgus alignment obtained in flatfoot reconstruction is primarily determined by the MCO procedure and can be modeled linearly. We believe that the hindfoot alignment view can serve as a valuable preoperative measurement to help surgeons adjust the proper amount of correction intraoperatively. LEVEL OF EVIDENCE: Level IV, prospective case series. SN - 1071-1007 UR - https://www.unboundmedicine.com/medline/citation/23413053/The_contribution_of_medializing_calcaneal_osteotomy_on_hindfoot_alignment_in_the_reconstruction_of_the_stage_II_adult_acquired_flatfoot_deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100712460225?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -