Lateralizing calcaneal osteotomy using a medial approach effectively corrected hindfoot deformity
SEATTLE — At the American Orthopaedic Foot and Ankle Society Annual Meeting, a presenter said cavovarus reconstruction with a lateralizing calcaneal osteotomy by way of a medial approach posed low risk of neurologic injury and offered “powerful” translational correction for patients with hindfoot varus deformity.
“The medial approach is safe. It has its benefits [and] you can get adequate translation over 1 cm,” David E. Jaffe, MD, said during his presentation. “You can perform a simultaneous plantarflexion release, which can aid in your cavovarus reconstruction. This can also eliminate small skin-graft bridges if lateral access is needed, which is often the case in cavovarus reconstruction, and you are completely avoiding the sural nerve edges.”
Jaffe and colleagues performed a retrospective review of 24 patients who underwent cavovarus reconstruction with a lateralizing calcaneus osteotomy via medial approach. Investigators collected patient demographics, operative reports and postoperative clinical notes and reviewed for the presence of immediate tarsal tunnel syndrome, concomitant procedures performed, perioperative complications, preoperative neurologic examinations and postoperative neurologic complications. To determine the location of osteotomy in relation to the posterior tubercle, investigators collected postoperative radiographs.
Investigators found that during the immediate postoperative period, no patient developed acute tarsal tunnel syndrome. Permanent postoperative tibial nerve palsy was also not seen in any patient. Late onset of lateral foot numbness was seen in one patient; however, this resolved 12 months after surgery. Diffuse numbness of the entire foot was seen in one patient.
Irrigation and debridement, antibiotics and plastic surgery closure were needed for two incision-related complications. Removal of symptomatic calcaneal hardware was needed in three patients, and delayed union of the osteotomy and a broken calcaneus screw was seen in one patient. – by Monica Jaramillo
Jaffe DE, et al. Cavovarus reconstruction using a lateralizing calcaneal osteotomy via medial approach. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; July 12-15, 2017; Seattle.
Disclosure: Jaffe reports no relevant financial disclosures.