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Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity.
Foot Ankle Int. 2015 Aug; 36(8):919-27.FA

Abstract

BACKGROUND

While previous work has demonstrated a linear relationship between the amount of medializing calcaneal osteotomy (MCO) and the change in radiographic hindfoot alignment following reconstruction, an ideal postoperative hindfoot alignment has yet to be reported. The aim of this study was to identify an optimal postoperative hindfoot alignment by correlating radiographic alignment with patient outcomes.

METHODS

Fifty-five feet in 55 patients underwent flatfoot reconstruction for stage II adult-acquired flatfoot deformity (AAFD) by 2 fellowship-trained foot and ankle orthopedic surgeons. Hindfoot alignment was determined as previously described by Saltzman and el-Khoury.(23) Changes in pre- and postoperative scores in each Foot and Ankle Outcome Score (FAOS) subscale were calculated for patients in postoperative hindfoot valgus (≥0 mm valgus, n = 18), mild varus (>0 to 5 mm varus, n = 17), and moderate varus (>5 mm varus, n = 20). Analysis of variance and post hoc Tukey's tests were used to compare the change in FAOS results between these 3 groups.

RESULTS

At 22 months or more postoperatively, patients corrected to mild hindfoot varus showed a significantly greater improvement in the FAOS Pain subscale compared with patients in valgus (P = .04) and the Symptoms subscale compared with patients in moderate varus (P = .03). Although mild hindfoot varus did not differ significantly from moderate varus or valgus in the other subscales, mild hindfoot varus did not perform worse than these alignments in any FAOS subscale. No statistically significant correlations between intraoperative MCO slide distances and FAOS subscales were found.

CONCLUSIONS

Our study indicates that correction of hindfoot alignment to between 0 and 5 mm of varus on the hindfoot alignment view (clinically a straight heel) following stage II flatfoot reconstruction was associated with the greatest improvement in clinical outcomes following hindfoot reconstruction in stage II AAFD.

LEVEL OF EVIDENCE

Level III, comparative series.

Authors+Show Affiliations

Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA delandj@hss.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25948692

Citation

Conti, Matthew S., et al. "Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity." Foot & Ankle International, vol. 36, no. 8, 2015, pp. 919-27.
Conti MS, Ellis SJ, Chan JY, et al. Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. Foot Ankle Int. 2015;36(8):919-27.
Conti, M. S., Ellis, S. J., Chan, J. Y., Do, H. T., & Deland, J. T. (2015). Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. Foot & Ankle International, 36(8), 919-27. https://doi.org/10.1177/1071100715576918
Conti MS, et al. Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. Foot Ankle Int. 2015;36(8):919-27. PubMed PMID: 25948692.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. AU - Conti,Matthew S, AU - Ellis,Scott J, AU - Chan,Jeremy Y, AU - Do,Huong T, AU - Deland,Jonathan T, Y1 - 2015/05/06/ PY - 2015/5/8/entrez PY - 2015/5/8/pubmed PY - 2016/5/6/medline KW - adult-acquired flatfoot deformity KW - calcaneal osteotomy KW - hindfoot alignment KW - outcome studies KW - reconstruction SP - 919 EP - 27 JF - Foot & ankle international JO - Foot Ankle Int VL - 36 IS - 8 N2 - BACKGROUND: While previous work has demonstrated a linear relationship between the amount of medializing calcaneal osteotomy (MCO) and the change in radiographic hindfoot alignment following reconstruction, an ideal postoperative hindfoot alignment has yet to be reported. The aim of this study was to identify an optimal postoperative hindfoot alignment by correlating radiographic alignment with patient outcomes. METHODS: Fifty-five feet in 55 patients underwent flatfoot reconstruction for stage II adult-acquired flatfoot deformity (AAFD) by 2 fellowship-trained foot and ankle orthopedic surgeons. Hindfoot alignment was determined as previously described by Saltzman and el-Khoury.(23) Changes in pre- and postoperative scores in each Foot and Ankle Outcome Score (FAOS) subscale were calculated for patients in postoperative hindfoot valgus (≥0 mm valgus, n = 18), mild varus (>0 to 5 mm varus, n = 17), and moderate varus (>5 mm varus, n = 20). Analysis of variance and post hoc Tukey's tests were used to compare the change in FAOS results between these 3 groups. RESULTS: At 22 months or more postoperatively, patients corrected to mild hindfoot varus showed a significantly greater improvement in the FAOS Pain subscale compared with patients in valgus (P = .04) and the Symptoms subscale compared with patients in moderate varus (P = .03). Although mild hindfoot varus did not differ significantly from moderate varus or valgus in the other subscales, mild hindfoot varus did not perform worse than these alignments in any FAOS subscale. No statistically significant correlations between intraoperative MCO slide distances and FAOS subscales were found. CONCLUSIONS: Our study indicates that correction of hindfoot alignment to between 0 and 5 mm of varus on the hindfoot alignment view (clinically a straight heel) following stage II flatfoot reconstruction was associated with the greatest improvement in clinical outcomes following hindfoot reconstruction in stage II AAFD. LEVEL OF EVIDENCE: Level III, comparative series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/25948692/Optimal_Position_of_the_Heel_Following_Reconstruction_of_the_Stage_II_Adult_Acquired_Flatfoot_Deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100715576918?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -