Effect of Lateral Column Lengthening on Subtalar Motion in a Cadaveric Model

Harris, Mitchel; Hedrick, Brittany; Zide, Jacob R.; Thomas, D.; Shivers, Claire; Seibert, Matthew; Pierce, William A.; Kanaan, Yassine; Riccio, Anthony I.

doi:10.1177/1071100720970189

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Subtalar eversion motion was most strongly related to the lateralization of plantar pressure during stance. The question of whether LCL affects the subtalar joint motion has been a subject of debate, as reductions in the subtalar range of motion compared with controls were demonstrated in 1 study while another study showed no differences after a 12-mm LCL procedure 15,16 . In the present study, subtalar eversion motion was strongly influenced by increasing wedge size.…”

Section: Discussionmentioning

confidence: 99%

Passive Eversion Assessment for Progressive Collapsing Foot Deformity After Lateral Column Lengthening

Kim,

Hoffman,

Ellis

et al. 2024

Journal of Bone and Joint Surgery

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Background: Reduced hindfoot eversion motion has been proposed as a cause of increased lateral foot pressure following lateral column lengthening (LCL) for progressive collapsing foot deformity (PCFD). A subjective intraoperative assessment of passive eversion has been suggested to help evaluate correction; however, it is unclear how passive eversion correlates with objective measurements of foot stiffness. Our objectives were to quantify the relationship between the maximum passive eversion in hindfoot joints following LCL with plantar pressure during stance and to determine the influence of wedge size on these outcomes. Methods: Ten cadaveric specimens extending from the mid-tibia distally were tested on a 6-degrees-of-freedom robot to simulate the stance phase of level walking. Five conditions were tested: intact, simulated PCFD, and 3 LCL wedge conditions (4, 6, and 8 mm). Outcomes included the lateral-to-medial forefoot plantar pressure (LM) ratio during stance and the maximum passive eversion measured in the hindfoot joints. Simple linear regressions were performed to evaluate relationships between outcomes and wedge sizes. Results: A strong negative relationship was found between passive subtalar eversion and the LM ratio during stance (r[38] = −0.46; p = 0.0007), but not between passive talonavicular eversion and the LM ratio (r[38] = −0.02; p = 0.37). Wedge size was strongly related to subtalar eversion (r[38] = −0.77; p < 0.0001), talonavicular eversion (r[38] = −0.55; p = 0.0003), and the LM ratio (r[38] = 0.70; p < 0.0001). Increased wedge size resulted in average decreases in subtalar and talonavicular eversion of 1.0° (95% confidence interval [CI]: 0.8° to 1.3°) and 1.2° (95% CI: 0.6° to 1.6°), respectively. Increased wedge size also increased the LM ratio by 0.38 (95% CI: 0.25 to 0.50), indicating a lateral shift in plantar pressure. Conclusions: Decreased hindfoot eversion following LCL was related to increased lateral plantar pressure during stance. Increasing wedge size correlated with decreasing passive hindfoot eversion and increasing lateral plantar pressure, suggesting that intraoperative preservation of eversion motion may be important for preventing excessive lateral loading. Clinical Relevance: To avoid overcorrection or undercorrection of the deformity, hindfoot eversion assessment in addition to radiographic evaluation may be important for optimizing the amount of lengthening to achieve successful LCL.

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Section: Discussionmentioning

confidence: 99%

Passive Eversion Assessment for Progressive Collapsing Foot Deformity After Lateral Column Lengthening

Kim,

Hoffman,

Ellis

et al. 2024

Journal of Bone and Joint Surgery

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“…A recent report showed that no significant changes in subtalar motion were observed following LCL in the biomechanical cadaveric study. 18 On the other hand, clinical studies showed mixed results. 5,26 No matter how intra-articular invasion affects the subtalar motion, we preserve the integrity of the subtalar joint to reduce the effect on subtalar motion, which is evaluated as insignificant change in our series.…”

Section: Discussionmentioning

confidence: 99%

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

et al. 2021

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Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

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“…Traditional biomechanical studies are mostly carried out using cadaver models, making it difficult to acquire the strain data of soft tissues and contact characteristics [8]. In this regard, computer simulation based on finite element (FE) analysis is able to obtain internal biomechanical information such as soft tissue strain and joint contact characteristics under predetermined conditions and controlled environment.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical effects of Evans versus Hintermann osteotomy for treating adult acquired flatfoot deformity: a patient-specific finite element investigation

Xu,

Liu,

et al. 2024

J Orthop Surg Res

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Background Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good clinical results. The aim of this study was to compare these two procedures in terms of corrective ability and biomechanics influence on the Chopart and subtalar joints through finite element (FE) analysis. Methods Twelve patient-specific FE models were established and validated. The Hintermann osteotomy was performed between the medial and posterior facets of the subtalar joint; while, the Evans osteotomy was performed on the anterior neck of the calcaneus around 10 mm from the calcaneocuboid joint surface. In each procedure, a triangular wedge of varying size was inserted at the lateral edge. The two procedures were then compared based on the measured strains of superomedial calcaneonavicular ligaments and planter facia, the talus-first metatarsal angle, and the contact characteristics of talonavicular, calcaneocuboid and subtalar joints. Results The Hintermann procedure achieved a greater correction of the talus-first metatarsal angle than Evans when using grafts of the same size, indicating that Hintermann had stronger corrective ability. However, its distributions of von-Mises stress in the subtalar, talonavicular and calcaneocuboid joints were less homogeneous than those of Evans. In addition, the strains of superomedial calcaneonavicular ligaments and planter facia of Hintermann were also greater than those of Evans, but both generally within the safe range (less than 6%). Conclusion This FE analysis study indicates that both Evans and Hintermann procedures have good corrective ability for AAFD. Compared to Evans, Hintermann procedure can provide a stronger corrective effect while causing greater disturbance to the biomechanics of Chopart joints, which may be an important mechanism of arthritis. Nevertheless, it yields a better protection to the subtalar joint than Evans osteotomy. Clinical relevance Both Evans and Hintermann LCL surgeries have a considerable impact on adjacent joints and ligament tissues. Such effects alongside the overcorrection problem should be cautiously considered when choosing the specific surgical method. Level of evidence Level III, case–control study.

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Effect of Lateral Column Lengthening on Subtalar Motion in a Cadaveric Model

Cited by 4 publications

References 21 publications

Passive Eversion Assessment for Progressive Collapsing Foot Deformity After Lateral Column Lengthening

Passive Eversion Assessment for Progressive Collapsing Foot Deformity After Lateral Column Lengthening

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

Biomechanical effects of Evans versus Hintermann osteotomy for treating adult acquired flatfoot deformity: a patient-specific finite element investigation

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