Sensitivity of Plantar Pressure and Talonavicular Alignment to Lateral Column Lengthening in Flatfoot Reconstruction

Oh, Irvin; Imhauser, Carl W.; Choi, Daniel; Williams, Benjamin R.; Ellis, Scott J.; Deland, Jonathan T.

doi:10.2106/jbjs.k.01032

Cited by 57 publications

(90 citation statements)

References 39 publications

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“…We found that the pressure of the medial column increased significantly, while that of the lateral column decreased after the establishment of the flatfoot model, which was statistically different from the intact foot. As the graft increased incrementally, lateral plantar pressures increased gradually and medial plantar pressures decreased at the same time, similar to the results of prior studies on the Evans osteotomy [10, 19, 20]. In this study, the pressure of the lateral column was approximately equal to that of the intact foot with a 2 mm LCL, while the pressure of the medial column was 34.7 kPa, which showed no statistical difference compared with the flatfoot condition.…”

Section: Discussionsupporting

confidence: 88%

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study

Zhou

Ren

et al. 2017

BioMed Research International

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Purpose. To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage II B adult-acquired flatfoot deformity in cadaver. Methods. Six cadaver specimens were loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, and (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results. Compared with the flatfoot model, the LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs (p < .05). Compared with the intact foot, the above angles of the LCLs showed no significant difference except the 2 mm LCL. In terms of forefoot pressure, medial pressure of the 2 mm LCL (p = .044) and lateral pressure of the 3, 4, and 5 mm LCLs showed statistical differences (p < .05), but lateral pressure of the 3 mm LCL was not more than the intact foot as compared to the 4 and 5 mm LCLs, which was less than medial pressure. Conclusion. Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage II B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.

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Section: Discussionsupporting

confidence: 88%

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study

Zhou

Ren

et al. 2017

BioMed Research International

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“…Davitt and Morgan also reported two cases of stress fractures of the fifth metatarsal following Evans’ calcaneal lengthening procedure 3 . Oh et al (2013) demonstrated the effects of different amounts of LCL on lateral plantar pressures of the foot 15 . They found significantly decreased talonavicular uncoverage and increased lateral column plantar pressures as they increased the amount of LCL performed from 6 mm to 10 mm 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Oh et al (2013) demonstrated the effects of different amounts of LCL on lateral plantar pressures of the foot 15 . They found significantly decreased talonavicular uncoverage and increased lateral column plantar pressures as they increased the amount of LCL performed from 6 mm to 10 mm 15 . These studies suggest that overcorrection of the abduction deformity in patients with stage II AAFD may lead to inferior clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

et al. 2015

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Background No studies investigating the effect of midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from AP radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Methods Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors’ institution that underwent flatfoot reconstruction for stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with two or more measurements in the abduction category were classified as the abduction group (n=30); those with one or fewer measurements in the abduction category were placed in the adduction group (n=25). Preoperative FAOS and postoperative FAOS with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. Results Patients corrected to a position of adduction showed a significantly lower improvement in the FAOS daily activities (p=0.012) and quality of life subscales (p=0.046). Mean improvement in subscale score for the adducted group was lower for pain (p=0.052) and sports activities (p=0.085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (p=0.372) between groups was found. Conclusions Correction of the talonavicular joint to a position of adduction following stage II AAFD is associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in the reconstruction of stage II AAFD. Level of Evidence Therapeutic Level III

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“…It is challenging to assess hindfoot alignment intraoperatively, and surgeons often elect to perform the MCO first to achieve the ideal hindfoot alignment before performing the LCL to correct the midfoot deformity. While patients are often satisfied with these procedures, overcorrection and pain still occur, 8,13 and care should be taken when combining LCL and MCO procedures. Our results support a change in operative planning, to first correct the midfoot deformity with a LCL followed by performing the MCO to achieve ideal hindfoot alignment.…”

Section: Discussionmentioning

confidence: 99%

Lateral Column Lengthening Corrects Hindfoot Valgus in a Cadaveric Flatfoot Model

et al. 2015

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Sensitivity of Plantar Pressure and Talonavicular Alignment to Lateral Column Lengthening in Flatfoot Reconstruction

Abstract: The lateral column should be lengthened judiciously, as a 2-mm difference leads to significant difference not only in angular correction of the talonavicular joint but also with regard to pressure in the lateral aspect of the forefoot.

Cited by 57 publications

References 39 publications

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study

Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

Lateral Column Lengthening Corrects Hindfoot Valgus in a Cadaveric Flatfoot Model

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