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Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity.
Foot Ankle Int. 2019 Aug; 40(8):914-922.FA

Abstract

BACKGROUND

Medial displacement calcaneus tuberosity osteotomy and anterior process lengthening calcaneus osteotomy are traditional single-plane osteotomy techniques used in adult acquired flatfoot deformity reconstruction. More recently, 3-plane step-cut osteotomies were described for each of these and shown to offer improved rotational stability via the horizontal limb. However, a major technical challenge is achieving a sufficiently long horizontal limb to correct deformity through lengthening without losing bony apposition. Combining the anterior process and tuberosity step-cuts using an elongated horizontal limb alleviates this technical challenge, creates a very large surface area for bony healing, and utilizes a single incision. We hypothesized that the Z-cut osteotomy would achieve clinical and radiographic flatfoot deformity correction with a high union rate.

METHODS

This was an institutional review board-approved retrospective study of 16 patients who underwent Z-cut osteotomy for the treatment of moderate to severe symptomatic adult acquired flatfoot deformity, stage IIA/B. The mean radiographic follow-up was 8.8 months, while the mean clinical follow-up was 2.36 years. Radiographic correction was assessed via weightbearing radiographs taken preoperatively and at a mean of 26 ± 2 weeks postoperatively. Measurements included Meary's angle (talo-first metatarsal angle), talonavicular (TN) joint uncoverage percentage, TN incongruency angle, medial cuneiform to fifth metatarsal height, and calcaneal pitch. Union rates and clinical outcomes via the Foot Function Index (FFI) score were assessed preoperatively and at a mean of 29 months following surgery. Paired t test was used to compare both clinical and radiographic outcomes with statistical significance set at P < .05.

RESULTS

Fifteen of 16 patients returned an FFI questionnaire with a mean improvement of 52.1 to 10.3 (P = .002). The calcaneal pitch improved from 12.7 to 15.2 degrees (P = .002), the medial cuneiform-fifth metatarsal distance improved from 12.8 to 18.5 mm (P = .002), the TN coverage angle improved from 21.3 to 9.1 degrees (P < .001), the TN uncoverage percentage improved from 32.9% to 20.3% (P < .001), and the TN incongruency angle improved from 41.4 to 19.9 degrees (P < .001). Deformity correction was well maintained in 13 of 16 patients at final follow-up. The union rate of the osteotomy was 100%. Three patients had symptomatic hardware initially; 1 patient required removal of hardware. One patient developed a superficial infection that cleared. Another patient developed peroneal tendonitis, which resolved with corticosteroid injection.

CONCLUSION

The Z-cut osteotomy is a novel, technically simplified, single-incision, single-osteotomy alternative to the previously described double calcaneus osteotomy techniques for reconstructing flexible moderate to severe adult acquired flatfoot deformity that offers comparable short-term clinical and radiographic outcomes with acceptably low complications.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Authors+Show Affiliations

1 OhioHealth, Columbus, OH, USA.2 Integrated Orthopedics, Phoenix, AZ, USA.3 Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.4 Orthopedic Foot and Ankle Center, Westerville, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31088118

Citation

Ebaugh, M Pierce, et al. "Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity." Foot & Ankle International, vol. 40, no. 8, 2019, pp. 914-922.
Ebaugh MP, Larson DR, Reb CW, et al. Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2019;40(8):914-922.
Ebaugh, M. P., Larson, D. R., Reb, C. W., & Berlet, G. C. (2019). Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity. Foot & Ankle International, 40(8), 914-922. https://doi.org/10.1177/1071100719847662
Ebaugh MP, et al. Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2019;40(8):914-922. PubMed PMID: 31088118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity. AU - Ebaugh,M Pierce, AU - Larson,David R, AU - Reb,Christopher W, AU - Berlet,Gregory C, Y1 - 2019/05/14/ PY - 2019/5/16/pubmed PY - 2020/3/13/medline PY - 2019/5/16/entrez KW - Extended Z-cut KW - adult acquired flatfoot KW - calcaneal osteotomy SP - 914 EP - 922 JF - Foot & ankle international JO - Foot Ankle Int VL - 40 IS - 8 N2 - BACKGROUND: Medial displacement calcaneus tuberosity osteotomy and anterior process lengthening calcaneus osteotomy are traditional single-plane osteotomy techniques used in adult acquired flatfoot deformity reconstruction. More recently, 3-plane step-cut osteotomies were described for each of these and shown to offer improved rotational stability via the horizontal limb. However, a major technical challenge is achieving a sufficiently long horizontal limb to correct deformity through lengthening without losing bony apposition. Combining the anterior process and tuberosity step-cuts using an elongated horizontal limb alleviates this technical challenge, creates a very large surface area for bony healing, and utilizes a single incision. We hypothesized that the Z-cut osteotomy would achieve clinical and radiographic flatfoot deformity correction with a high union rate. METHODS: This was an institutional review board-approved retrospective study of 16 patients who underwent Z-cut osteotomy for the treatment of moderate to severe symptomatic adult acquired flatfoot deformity, stage IIA/B. The mean radiographic follow-up was 8.8 months, while the mean clinical follow-up was 2.36 years. Radiographic correction was assessed via weightbearing radiographs taken preoperatively and at a mean of 26 ± 2 weeks postoperatively. Measurements included Meary's angle (talo-first metatarsal angle), talonavicular (TN) joint uncoverage percentage, TN incongruency angle, medial cuneiform to fifth metatarsal height, and calcaneal pitch. Union rates and clinical outcomes via the Foot Function Index (FFI) score were assessed preoperatively and at a mean of 29 months following surgery. Paired t test was used to compare both clinical and radiographic outcomes with statistical significance set at P < .05. RESULTS: Fifteen of 16 patients returned an FFI questionnaire with a mean improvement of 52.1 to 10.3 (P = .002). The calcaneal pitch improved from 12.7 to 15.2 degrees (P = .002), the medial cuneiform-fifth metatarsal distance improved from 12.8 to 18.5 mm (P = .002), the TN coverage angle improved from 21.3 to 9.1 degrees (P < .001), the TN uncoverage percentage improved from 32.9% to 20.3% (P < .001), and the TN incongruency angle improved from 41.4 to 19.9 degrees (P < .001). Deformity correction was well maintained in 13 of 16 patients at final follow-up. The union rate of the osteotomy was 100%. Three patients had symptomatic hardware initially; 1 patient required removal of hardware. One patient developed a superficial infection that cleared. Another patient developed peroneal tendonitis, which resolved with corticosteroid injection. CONCLUSION: The Z-cut osteotomy is a novel, technically simplified, single-incision, single-osteotomy alternative to the previously described double calcaneus osteotomy techniques for reconstructing flexible moderate to severe adult acquired flatfoot deformity that offers comparable short-term clinical and radiographic outcomes with acceptably low complications. LEVEL OF EVIDENCE: Level IV, retrospective case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/31088118/Outcomes_of_the_Extended_Z_Cut_Osteotomy_for_Correction_of_Adult_Acquired_Flatfoot_Deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100719847662?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -