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Calcaneal "Z" osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model.
Foot Ankle Int. 2014 Dec; 35(12):1350-7.FA

Abstract

BACKGROUND

Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal "Z" osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot.

METHODS

Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after "Z" osteotomy.

RESULTS

The calcaneal "Z" osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal "Z" osteotomy did not differ from those measured after varus triple fusion.

CONCLUSION

In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal "Z" osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions.

CLINICAL RELEVANCE

The results provide additional information on which to base treatment after triple arthrodesis with varus malunion.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Clinica Alemana de Santiago, Santiago, Chile.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA james.deorio@duke.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25125512

Citation

Zanolli, Diego H., et al. "Calcaneal "Z" Osteotomy Effect On Hindfoot Varus After Triple Arthrodesis in a Cadaver Model." Foot & Ankle International, vol. 35, no. 12, 2014, pp. 1350-7.
Zanolli DH, Glisson RR, Utturkar GM, et al. Calcaneal "Z" osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model. Foot Ankle Int. 2014;35(12):1350-7.
Zanolli, D. H., Glisson, R. R., Utturkar, G. M., Eckel, T. T., & DeOrio, J. K. (2014). Calcaneal "Z" osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model. Foot & Ankle International, 35(12), 1350-7. https://doi.org/10.1177/1071100714547364
Zanolli DH, et al. Calcaneal "Z" Osteotomy Effect On Hindfoot Varus After Triple Arthrodesis in a Cadaver Model. Foot Ankle Int. 2014;35(12):1350-7. PubMed PMID: 25125512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcaneal "Z" osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model. AU - Zanolli,Diego H, AU - Glisson,Richard R, AU - Utturkar,Gangadhar M, AU - Eckel,Tobin T, AU - DeOrio,James K, Y1 - 2014/08/14/ PY - 2014/8/16/entrez PY - 2014/8/16/pubmed PY - 2015/8/1/medline KW - biomechanics KW - forefoot disorders SP - 1350 EP - 7 JF - Foot & ankle international JO - Foot Ankle Int VL - 35 IS - 12 N2 - BACKGROUND: Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal "Z" osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot. METHODS: Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after "Z" osteotomy. RESULTS: The calcaneal "Z" osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal "Z" osteotomy did not differ from those measured after varus triple fusion. CONCLUSION: In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal "Z" osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions. CLINICAL RELEVANCE: The results provide additional information on which to base treatment after triple arthrodesis with varus malunion. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/25125512/Calcaneal_"Z"_osteotomy_effect_on_hindfoot_varus_after_triple_arthrodesis_in_a_cadaver_model_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100714547364?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -