A Modified Technique for Lateral Column Lengthening as Part of Adult Acquired Flatfoot Deformity Correction: An Intact Medial Calcaneal Cortex, a Low-Profile Locking Plate With a Combination of Autologous Calcaneal Bone Graft and Demineralized Human Bone Matrix

Abstract

Adult acquired flatfoot deformity encompasses deformities of the entire foot and ankle, with most clinical presentations comprising of a flexible planovalgus deformity and forefoot abduction. Numerous operative procedures have been proposed, and a lateral column–lengthening procedure is advocated to correct the forefoot abduction. Autologous iliac crest bone graft is routinely inserted into the opening-wedge osteotomy at the anterior calcaneum. Fixation methods are also variable with increasing use of locking plates to achieve stability at this osteotomy. Harvesting the iliac crest graft exposes the patient to significant donor site morbidity. We describe a modified lateral column–lengthening technique, leaving the medial calcaneum cortex intact, packing a combination of autologous calcaneal bone graft, and demineralized bone matrix into the osteotomy site, fixed with a low-profile locking plate. In the short term, our technique offers reduced rates of wound complications, symptomatic hardware, nonunion, and deformity recurrence when compared with published rates. Level of Evidence: Level IV, Case Series (retrospective).