Stage IIB Flatfoot Reconstruction Using Literature-based Equations for Heel Slide and Lateral Column Lengthening

Adult acquired flatfoot deformity (AAFD) is a disease characterized by insufficiency of the medial longitudinal arch of the foot. Stage IIB AAFD occurs when there is a passively correctible collapse of the arch, increased abduction at the talonavicular joint, and hindfoot valgus. In the mid-1990s, a flatfoot reconstruction was proposed that combined the use of a medializing calcaneal osteotomy (MCO), a lateral column lengthening (LCL), and soft-tissue procedures for the treatment of stage IIB AAFD. More recent literature has suggested guidelines for the amount of correction necessary for each of these procedures based on individual deformity. In this paper, we describe our technique for flatfoot reconstruction for stage IIB AAFD, which includes a MCO, LCL, and flexor digitorum longus (FDL) transfer. Importantly, we discuss our preferred method of preoperatively planning the amount of medial translation for the MCO as well as the maximum amount of LCL to prevent overcorrection of the abduction deformity. This allows us to tailor the reconstruction and optimize our results. Studies looking at outcomes following flatfoot reconstructions for stage IIB AAFD demonstrate excellent short-term and long-term results. We conclude by discussing complications of the operation, postoperative management, and the future of the technique.
Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Source: Techniques in Foot and Ankle Surgery - November 15, 2017 Category: Orthopaedics Tags: CME Aricle Source Type: research