The Application of Calcaneal Z Osteotomy in Treating Type ⅡB Adult Acquired Flatfoot Deformity

Abstract

Category: Hindfoot Introduction/Purpose: A retrospective control study to evaluate the application of calcaneal Z osteotomy in treating type ⅡB adult acquired flatfoot deformity. Methods: From September 2011 to March 2013, 20 cases of typeⅡB adult acquired flatfoot (according to Myerson’s classification) were treated by calcaneal Z osteotomy combined with medial soft tissue reconstructing. There were 4 males and 16 females with a mean age of 52.6 years (range 49 to 72 years). A Z osteotomy of the calcaneus was performed instead of a lateral column lengthening or a double calcaneal osteotomy for purpose of correct the forefoot abduction and hind foot valgus deformity. The medial soft tissue procedure included posterior tibial tendon resection and Flexor digitorum longus tendon transfer. American Orthopaedic Foot and Ankle Society (AOFAS) score and radiological assessments were used to evaluate the conditions before and after operation. Results: Eventually, 19 patients were followed up with an average duration of 26.5 months (range, 18-56 months). AOFAS scores were 80-90 points in 11 patients, 90-100 points in 6 patients and the excellent and good rate was 89% (17/19). The specific indexes of X-ray improved obviously (P < 0.01). The anteroposterior talocalcaneal angle decreased by 12°, lateral talar first metatarsal angle decreased by 15°, and talonavicular coverage angle decreased by 7°. There was no calcaneal-cuboid joint symptom in this group of patients. All these cases got good bone healing. Conclusion: The calcaneal Z osteotomy can correct the hind-foot deformity in three dimensions and can act as a lateral column lengthening in treating type ⅡB adult acquired flatfoot. The complication of this procedure is minimal.