The Importance of the Medial Column in Progressive Collapsing Foot Deformity

Gross, Christopher; Jackson, J. Benjamin

doi:10.1016/j.fcl.2021.06.001

Cited by 5 publications

(5 citation statements)

References 56 publications

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“…16 Failure to correct residual forefoot varus may result in recurrence of the deformity, and in the flexible PCFD, a number of osteotomies and fusions are available to aid in improving alignment of the medial column. 11 A dorsal opening wedge medial cuneiform osteotomy (Cotton) osteotomy has been shown to correct residual forefoot varus and medial column instability in PCFD. 14,19 However, the amount of bony correction that should be performed remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…27 Operative management of flexible PCFD often includes a flexor digitorum longus transfer, medializing calcaneal osteotomy, and a procedure to stabilize the medial column and correct the residual forefoot varus deformity. 11 An opening wedge medial cuneiform osteotomy, a first tarsometatarsal fusion, or a naviculocuneiform fusion have all been used to plantarflex the first ray and provide stability to the medial column. 4,6,7,16 Tendon transfers have recently been proposed to support the medial column in flexible PCFD dynamically.…”

Section: Introductionmentioning

confidence: 99%

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Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study

Conti,

Kim,

Hoffman

et al. 2024

Foot Ankle Int.

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Background: Although operative treatment of the flexible progressive collapsing foot deformity (PCFD) remains controversial, correction of residual forefoot varus and stabilization of the medial column are important components of reconstruction. A peroneus brevis (PB) to peroneus longus (PL) tendon transfer has been proposed to address these deformities. The aim of our study was to determine the effect of an isolated PB-to-PL transfer on medial column kinematics and plantar pressures in a simulated PCFD (sPCFD) cadaveric model. Methods: The stance phase of level walking was simulated in 10 midtibia cadaveric specimens using a validated 6–degree of freedom robot. Bone motions and plantar pressure were collected in 3 conditions: intact, sPCFD, and after PB-to-PL transfer. The PB-to-PL transfer was performed by transecting the PB and advancing the proximal stump 1 cm into the PL. Outcome measures included the change in joint rotation of the talonavicular, first naviculocuneiform, and first tarsometatarsal joints between conditions. Plantar pressure outcome measures included the maximum force, peak pressure under the first metatarsal, and the lateral-to-medial forefoot average pressure ratio. Results: Compared to the sPCFD condition, the PB-to-PL transfer resulted in significant increases in talonavicular plantarflexion and adduction of 68% and 72%, respectively, during simulated late stance phase. Talonavicular eversion also decreased in simulated late stance by 53%. Relative to the sPCFD condition, the PB-to-PL transfer also resulted in a 17% increase ( P = .045) in maximum force and a 45-kPa increase ( P = .038) in peak pressure under the first metatarsal, along with a medial shift in forefoot pressure. Conclusion: The results from this cadaver-based simulation suggest that the addition of a PB-to-PL transfer as part of the surgical management of the flexible PCFD may aid in correction of deformity and increase the plantarflexion force under the first metatarsal. Clinical Relevance: This study provides biomechanical evidence to support the addition of a PB-to-PL tendon transfer in the surgical treatment of flexible PCFD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study

Conti,

Kim,

Hoffman

et al. 2024

Foot Ankle Int.

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“…The importance of the first ray in restoring the mechanical function of foot tripod has been highlighted in the literature [ 3 , 10 , 16 , 30 , 60 – 62 ]. An unstable medial column has been linked to the pathogenesis of PCFD, HV, and MA [ 8 , 9 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…The challenges of preserving first ray length and avoiding first ray dorsiflexion when performing a conventional modified Lapidus first TMT joint fusion are considerable. The results of shortening and absence of plantarflexion might hinder the mechanical advantage that the first ray could play in correcting medial longitudinal arch collapse in patients with PCFD, HV and MA, which could be linked to recurrence and progression of the deformities [ 10 , 32 ]. An expected loss in first metatarsal length of up to 4.1 mm has been described in clinical studies and up to 8.1 mm shortening has been reported in cadaveric studies [ 25 , 26 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Ehret

Walt

Chinelati

et al. 2022

Arch Orthop Trauma Surg

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Introduction Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. Methods In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. Results A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3–12) and median allograft size was 8 mm (range 5–19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7–12.1°; p < 0.0001). Conclusion In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. Level of evidence Level II, prospective cohort study.

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“…The identification of classes B (midfoot abduction) and C (medial column instability), in particular, can be incremented with the technology due to its multiplane capability (31) . Instability of the tarsometatatarsal or naviculocuneiform joints, in the form of plantar gapping, dorsal subluxation, or arthritis, can change the therapeutic approach of PCFD (33)(34)(35) . Foot tripod reestablishment through a medial longitudinal arch stabilization procedure directed to the apex of the deformity is a fundamental step of the reconstruction plan (36)(37)(38) .…”

Section: Weight-bearing Computed Tomography (Wbct)mentioning

confidence: 99%

Progressive collapsing foot deformity: how to use new knowledge in developing countries

Barbachan Mansur,

Dibbern,

César Netto

2024

J Foot Ankle

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The 2019 progressive collapsing foot deformity (PCFD) consensus did not only change the disease nomenclature and provided a new classification for the condition formerly known as flatfoot deformity. It was also the pinnacle of a revolution in the field in terms of knowledge and clinical perspectives. The use of advanced imaging, such as weight-bearing computed tomography, three-dimensional algorithms, and magnetic resonance, expanded the way we understand peritalar subluxation and how we can address it. However,much of these improvements felt short in terms of global reproducibility due to economic restraints. The objective of this review studyis to present PCFD new concepts through the lens and realities of developing countries, considering their potentially limited access tonovel technologies. Level of Evidence V; Expert opinion.

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The Importance of the Medial Column in Progressive Collapsing Foot Deformity

Cited by 5 publications

References 56 publications

Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study

Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Progressive collapsing foot deformity: how to use new knowledge in developing countries

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