The Collapsing Flatfoot: Bone Alignment, Bone Alignment, Bone Alignment!

Abstract

Stage II adult acquired flatfoot deformity involves a loss of the medial longitudinal arch and an increase in hindfoot valgus due to both soft tissue dysfunction and attenuation with subsequent collapse of the foot’s inherent bony architecture. Although there is an important role for soft tissue reconstruction in the majority of cases of adult acquired flatfoot deformity, any soft tissue procedure in the absence of correction of the underlying bony alignment will be prone to failure so these soft tissue procedures should only be performed after maximal bony realignment has been obtained. In this article, we discuss our approach to bony realignment of for stage II flatfoot through use of a medializing calcaneal osteotomy and lateral column lengthening procedures such as the Evan’s osteotomy and the stepcut lengthening calcaneal osteotomy to correct hindfoot valgus and forefoot abduction respectively. Rationale for treatment, indications, preoperative planning, surgical technique, and outcomes are discussed. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.