Lateral Column Lengthening by Calcaneal Osteotomy

Abstract

The surgical treatment of adult acquired flatfoot deformity secondary to posterior tibial tendon dysfunction is controversial, especially for the stage 2 posterior tibial tendon dysfunction in which the deformity is still flexible. It has been widely recognized that isolated soft tissue procedures do not provide stable correction of the deformity, which often progresses and becomes painful. For this reason, bony osteotomies have been combined with tendon transfers and ligament reconstruction in an attempt to give long-lasting correction of both pain and deformity. Lateral calcaneal lengthening osteotomy, as originally described by Evans in child flatfoot, was found to restore the medial longitudinal arch and to correct forefoot abduction, thus allowing to minimize the strain and to reach a successful function of the medial ligament reconstruction and tendon transfers. The closer the osteotomy of the calcaneus is to the calcaneocuboid joint, the more likely the anterior calcaneus becomes unstable, which, in turn, may provoke incongruency and pressure increase at the calcaneocuboid joint. This article describes the author's preferred more posteriorly located calcaneal osteotomy along the anterior border of the posterior subtalar facet.