Percutaneous displacement calcaneal osteotomy

Abstract

Gleich (1) first described in 1893 the calcaneal osteotomy as a plantar-medial wedge resection to increase the calcaneal inclination angle. Later, Dwyer (2) and Silver (3) each described closingand opening-wedge osteotomies for calcaneal realignment with promising results. Koutsogiannis (4) popularized the medial displacement osteotomy in 1971. It has been shown that the medial displacement osteotomy addresses the flatfoot deformity in all 3 planes (5). The calcaneal displacement osteotomy (CDO) can also be used to reposition the heel in all 3 cardinal body planes. The tuberosity can be rotated to accommodate a frontal-plane deformity. It can be translocated medially and laterally or in the sagittal plane (6). Several authors suggest that the complication rate for medial displacement osteotomies is low (7, 8). Wound complications, especially in immunocompromised individuals, may pose a threat to the outcome of the procedure. Furthermore, the relationships of the soft tissues on the medial side of the calcaneus must be understood to minimize trauma to this area. A recent study by Greene et al (9) analyzed the topography of the medial neuro vascular supply and its relationship to the site of the open CDO. They surveyed the medial plantar nerve, lateral plantar nerve, posterior tibial artery, and their branches. Neither the medial plantar nerve nor its branches crossed the osteotomy site in any of the 22 specimens. The lateral plantar nerve crossed the site in only 1 specimen; however, its calcaneal branch crossed the site 86% of the time. This intersection occurred at approximately 20% of the distance from the proximal portion of the calcaneus. Additionally, the second lateral plantar nerve branch crossed in 95% of the specimens at two-thirds from the proximal point. The posterior tibial artery crossed the osteotomy site in 2 specimens. Branches crossed in 77% of the cases at the midsection of the osteotomy. They concluded that, when performing the CDO, the