Effects of Medial Displacement Calcaneal Osteotomy and Calcaneal Z Osteotomy on Subtalar Joint Pressures: A Cadaveric Flatfoot Model

Patrick, Nathan; Lewis, Gregory S.; Roush, Evan P.; Kunselman, Allen R.; Cain, Jarrett D.

doi:10.1053/j.jfas.2016.07.009

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…After MDCO, there was a slight decrease of subtalar joint force from 211.4 N to 168.8 N, a decrease of contact area from 3.5cm 2 to 3.1cm 2 , and a decrease of peak contact pressure from 1810 kPa to 1276 kPa. However, all observed changes were not statistically significant [ 29 ]. Arangio et al demonstrated that pathologically increased force in the talo-navicular joint in a flatfoot model almost normalizes after MDCO.…”

Section: Resultsmentioning

confidence: 99%

Impact of the medial displacement calcaneal osteotomy on foot biomechanics: a systematic literature review

Mueller,

Frosch,

Barg

et al. 2024

Arch Orthop Trauma Surg

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Introduction Progressive collapsing foot deformity (PCFD), formally known as “adult-acquired flatfoot deformity” (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics. Materials and methods A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score. Results The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia (n = 6), medial longitudinal arch (n = 9), hind- and midfoot joint pressures (n = 10), Achilles tendon (n = 5), and gait pattern parameters (n = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46–92%) for in-vitro and a pooled mean Coleman score of 58 (range 56–65) points for clinical studies. Conclusion A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.

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Section: Resultsmentioning

confidence: 99%

Impact of the medial displacement calcaneal osteotomy on foot biomechanics: a systematic literature review

Mueller,

Frosch,

Barg

et al. 2024

Arch Orthop Trauma Surg

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“…One of the most widely used options is medializing calcaneal osteotomy (MCO). Recently, Zanolli et al and Patrick et al [15,29] published experimental studies focused on comparing the foot's structural correction achieved with MCO with some other strategies such as Z-osteotomy or lateral column lengthening. Other authors have evaluated the outcomes of MCO and both its effect on the Achilles tendon and its contribution to correcting signs of AAFD [11].…”

Section: Discussionmentioning

confidence: 99%

“…To simulate the MCO, calcaneus bone was modified, performing a 45-degrees transversal cut and translating the segment medially by 10-mm (See Figure 1) [15,22]. This modification was performed following the guidance of a specialist in foot surgeries.…”

Section: Fe Foot Model and Modificationsmentioning

confidence: 99%

“…Mathematics 2023, 11, 2243 2 of 14 Some cadaver-based models have been used to study the structural correction of the foot, evaluating changes in both the plantar footprint using force platforms, and foot arch falling using radiographic (Rx) images. For example, Patrick et al [15] measured the subtalar joint pressure produced by MCO using a cadaveric model suffering with flatfoot. They introduced a pressure sensor in the posterior facet joint, obtaining some, but limited, information about the effects of MCO on hindfoot joint pressures.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Effects of Medializing Calcaneal Osteotomy on Bones and the Tissues Related to Adult-Acquired Flatfoot Deformity: A Computational Study

et al. 2023

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Medializing calcaneal osteotomy (MCO) is a flatfoot treatment in stages IIa–IIb. It is true that structural correction is well known, but stress changes in foot tissues have not been sufficiently studied to date. Our objective was to evaluate the stress generated by MCO in both hindfoot and forefoot bones and in some soft tissues that support the arch. A finite element foot model was employed, simulating some situations related to flatfoot development. Results show a higher stress concentration around the osteotomy region when MCO is used in patients with plantar fascia weakness. Additionally, the stress increase found in lateral metatarsals would be the explanation for the long-term pain reported by patients.

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“…A previously described mechanical loading setup by our institution was used. 2,3,11 Briefly, the tibia potting was fastened to the vertical actuator of a servohydraulic test frame (FlexTest 40, MTS, Eden Prairie, MN). Tension was applied to the Achilles with a pneumatic cylinder.…”

Section: Loading Apparatusmentioning

confidence: 99%

Biomechanical Evaluation of Spring Ligament Augmentation With the FiberTape Device in a Cadaveric Flatfoot Model

et al. 2019

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Background: The structural importance of the spring ligament complex in arch stability has been described. Furthermore, the pathology of this complex is often noted in patients with posterior tibial tendon dysfunction. The purpose of this biomechanical study was to evaluate spring ligament repair alone versus augmentation with the FiberTape device in a cadaveric flatfoot model. Methods: Eight paired, below-the-knee, cadaveric specimens underwent flatfoot creation and reconstruction. The experimental group received augmentation with FiberTape (InternalBrace). After potting, specimens were loaded statically to measure talonavicular contact pressures and flatfoot correction. Cyclic loading was performed in a stepwise fashion. Loading was performed at 1 Hz and 100 cycles, at 100-N intervals from 500 to 1800 N, with the Achilles tendon also loaded to simulate weightbearing in the postoperative period. Results: Control specimen analysis demonstrated failures of 8 of 8 (100%) spring ligament suture repairs, occurring through suture cut-through (5 specimens), suture fatigue and elongation (2), or knot failure (1). One of 8 (12.5%) FiberTape-augmented repairs failed after cyclic loading. The difference in number of repair failures was statistically significant between the 2 groups ( P = .0014). Analysis revealed that at forces of 1600 N ( P = .03) and 1700 N ( P = .02) there were statistically significant differences between the FiberTape-augmented group and the control group, with a greater collapse in the lateral Meary talo–first metatarsal angle in the controls. There was no significant difference or abnormal increase in contact pressures of the talonavicular joint in both groups. Conclusion: FiberTape augmentation of the spring ligament appears biomechanically safe and effective under cyclic loading. Clinical relevance: Spring ligament augmentation with this device may be another biomechanically safe and reasonable treatment modality for surgeons during flatfoot reconstruction. It is possible that early protected weightbearing after these procedures may be performed.

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Effects of Medial Displacement Calcaneal Osteotomy and Calcaneal Z Osteotomy on Subtalar Joint Pressures: A Cadaveric Flatfoot Model

Cited by 11 publications

References 23 publications

Impact of the medial displacement calcaneal osteotomy on foot biomechanics: a systematic literature review

Impact of the medial displacement calcaneal osteotomy on foot biomechanics: a systematic literature review

Biomechanical Effects of Medializing Calcaneal Osteotomy on Bones and the Tissues Related to Adult-Acquired Flatfoot Deformity: A Computational Study

Biomechanical Evaluation of Spring Ligament Augmentation With the FiberTape Device in a Cadaveric Flatfoot Model

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