Relationship of the Scarf Valgus-Inducing Osteotomy of the Calcaneus to the Medial Neurovascular Structures

Abstract

When performing the osteotomy one should keep in mind that vigorous sawing and large displacement can cause damage to the medial neurovascular structures.

Operative Treatment of the Cavovarus Foot

“…2 In addition, it should be noted that these osteotomies are technically more challenging, require a greater amount of dissection, and theoretically place more risk on the neurovascular structures including the sural nerve within the operative field and the medial neurovascular structures crossing the osteotomy. 2,9,77 Although these calcaneal osteotomies have traditionally been performed via the lateral approach, in 2017 Jaffe et al 27 retrospectively evaluated 24 patients who underwent a cavovarus reconstruction including a lateralizing calcaneal osteotomy via a medial approach. They found no incidence of postoperative tarsal tunnel syndrome or tibial nerve palsy while achieving an average translation of 11.6 mm with 83% of the osteotomies being through the middle third of the calcaneus, which has been previously reported to be a potentially higher-risk area for tibial nerve symptoms.…”

Tibial Nerve Palsy After Lateralizing Calcaneal Osteotomy

“…All patients had a reduction in the tarsal tunnel volume. The mean reduction of tarsal tunnel volume when comparing the nonoperated foot to the one operated with LCO was 2636 (1348) mm 3 , corresponding to a 10.2% volume reduction for the whole group. In the group without neurological deficit (10 patients), a volume reduction of 2732 (1440) mm 3 or 10.5% volume reduction was observed, whereas a 2152 (868) mm 3 reduction or 9% volume reduction was found in the 2 patients with neurological deficit (P = .60; Table 2).…”

“…Overview of the 15 patients (18 feet) with regards to operated side, tibial nerve palsy =1, no tibial nerve palsy=0, lateral displacement measured as lateral step at the osteotomy site (mm), distance from the most posterior edge of the subtalar joint (STJ) to the proximal part of the osteotomy (mm) and reduction of tarsal tunnel (TT) volume when comparing operated side to non-operated side (mm 3 Comparing feet with and without tibial nerve palsy after lateralizing calcaneal osteotomy with regards to mean tarsal tunnel volume reduction, percent decrease in tarsal tunnel volume, mean distance from osteotomy to the posterior edge of the subtalar (ST) joint and mean lateral displacement for the calcaneal tuberosity measured by lateral step at the osteotomy site. Mean lateral step after calcaneal osteotomy (mm) 5.8 (1.9) 5.6 (1.5) P = .90…”

“…Results: Three of the 18 feet examined had tibial nerve palsy at a mean follow-up of 51 months. The mean reduction in tarsal tunnel volume when comparing the contralateral nonoperated foot to the foot operated with LCO was 2732 mm 3 in the group without neurological deficit and 2152 mm 3 in the group with neurological deficit (P = .60).…”

Anatomy Basis and Clinical Significance of Various Types of Abductor Hallucis Superior Margin Arterial Arcades

“…Also, its applications are increasing (Gupta, 2007;Yoon et al, 2007;Zgonis et al, 2008;Vermeulen et al, 2011;Yang et al, 2011;Gu & Jeong, 2012). For expanding the cutting range of medial plantar flap and extending vascular pedicle of flap, Chen et al (1998), firstly named abductor superior margin arterial arcade in 1997 and proposed to use medial plantar flap with the arterial arcade as pedicle to multi-directionally transfer and repair foot skin defect.…”