Abstract
BackgroundEvans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents.MethodsWe retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites.ResultsThe calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001).ConclusionsEvans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.
Highlights
Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conserva‐ tive treatment fails
Evans calcaneal lengthening osteotomy, which was modified by Mosca, has been used to treat symptomatic pes planovalgus [3, 5, 6]
The probe was inserted over the dorsal surface of the calcaneus to explore the interval between the anterior and middle facets, and osteotomy was performed through the interfacet interval
Summary
Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conserva‐ tive treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteot‐ omy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Evans calcaneal lengthening osteotomy, which was modified by Mosca, has been used to treat symptomatic pes planovalgus [3, 5, 6] It realigns the foot by lengthening the lateral column and allowing further bone growth. To the best of our knowledge, no study has described the use of autologous mid-fibula bone grafts in Evans calcaneal lengthening
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