Adult acquired flexible flatfoot, treated by calcaneo-cuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: A prospective outcome study of 20 patients

Abstract

Background Several methods for the treatment of acquired flexible flatfoot have been described. Patients and methods We followed the outcome of calcaneocuboid distraction arthrodesis with lengthening of the lateral column prospectively in 20 patients (20 feet). The mean age of the patients was 55 (30-66) years and 16 were women. The lateral column lengthening was combined with percutaneous lengthening of the Achilles tendon and augmentation of the posterior tibial tendon in all patients. Fixed forefoot supination, hallux valgus, and/or symptomatic arthrosis, were corrected with arthrodesis of the first cuneiform-metatarsal joint (n = 8) and arthrodesis of the naviculo-cuneiform joint (n = 2). The Foot Function Index (FFI) and American Orthopedic Foot and Ankle Society (AOFAS) Clinical Rating Index hindfoot score (CRI) were completed preoperatively and at follow-up. Follow-up time was 25 (13-39) months. All patients were physically examined at follow-up at the outpatient clinic, and the overall satisfaction rate was registered. Standardized weightbearing radiographs were taken preoperatively and at follow-up. The lateral and dorsoplantar talometatarsal angle was measured, together with the ground-navicular distance.Results At follow-up, 17/20 feet had complete relief of pain or only minor symptoms. The overall patient satisfaction rate was excellent or good in 15 patients and 17 patients reported an increase in daily and/or recreational activities. 3 patients complained of pain at

Effects of surgical correction for the treatment of adult acquired flatfoot deformity: A computational investigation

“…The cuboid was then rotated internally about its medial border with the calcaneus such that a 10 mm wide, full depth (25 mm) triangular wedge (with 4 mm removed to eliminate protrusion into the subtalar joint) could be placed between the two bones 14,19,29,41. These were then fused to form the CCDA (Fig.…”

“…Radiographic views were created and referencing markers added for measures used in flatfoot diagnosis 1–3,6,10–12,14,15,23,41. Such markers described the Talo-1st MetaTarsal (L-T1MT), Calcaneal Pitch (L-CP), and TaloCalcaneal (L-TC) joint angles in the lateral view (Fig.…”

“…Posterior tibial tendon function is restored by tendon transfer, commonly the flexor digitorum longus 1,3,4,14–16. Joint alignment is restored with several osteotomies, which exhibit specific strengths and some similar correction of alignment.…”

“…Additional surgical corrections, classified as lateral column lengthening procedures, counter medial arch collapse, and forefoot abduction by means of lengthening/rotating the mid- and forefoot and are commonly performed in conjunction with an MCO. The Evans opening wedge osteotomy (Evans), and calcaneocuboid distraction arthrodesis (CCDA) are the most common lateral column procedures 1,4,5,14,15,17–22. While a wide range of angle changes are reported, correction of excessive forefoot abduction is the most significant outcome for a lateral column procedure.…”

“…Complications associated with the Evans and CCDA include non- or delayed union, incision site problems, arthritic development (notably at the calcaneocuboid joint for Evans), and tightness or pain in the lateral foot 14,18,23–26. The corrections can alter not only tissue loading and joint contact, but gait and foot biomechanics by impacting plantar pressure distributions 19,24,27–29.…”