Investigation of Lateral Column Lengthening Osteotomy on the Movement of the Calcaneus: A Cadaveric Study

CATEGORY: Hindfoot INTRODUCTION/PURPOSE: Lateral column lengthening calcaneus osteotomy has been used widely in treating Stage IIB flexible flatfoot deformity in order to shift the anterior segment of the calcaneus forwards, which improves the coverage of the talonavicular joint by forefoot adduction. The premise of this investigation is that in addition to shifting the forefoot anteriorly around the axis of the talar head, there is also a posterior translation of the tuberosity of the calcaneus which is detrimental in that the angle of Gissane then impinges upon the posterior facet of the subtalar joint causing pain. Our hypothesis is that in addition to anterior translation of the calcaneus, posterior shift of the calcaneal tuberosity occurs with lengthening osteotomy of the calcaneus. METHODS: An acute cadaveric flatfoot model was created on 5 fresh frozen cadaver feet with no previous foot and ankle deformity. In order to simulate the surgical scenario, the study was performed with no external load on the limb. A vertical osteotomy was performed 1 cm posterior of the calcaneocuboid joint. Commercially available precut wedges of 6 mm, 8 mm, 10 mm, and 12 mm were used for lateral column lengthening. After the insertion of the bone grafts, positional changes in sagittal plane of both the anterior and posterior calcaneus segments were monitored on lateral views under both fluoroscopy and a 3D digital high-resolution motion capture system. Results were calculated in percentage change from the base line horizontal distance between the talar and both anterior and posterior calcaneus markers before insertion of the wedges. RESULTS: According to fluoroscopic measurements, the anterior translation of the anterior calcaneus segment was 7.27%+/-0.06 for 6 mm wedge, 16.11%+/-0.06 for 8 mm wedge, 20.81%+/- 0.08 for 10 mm wedge and 18.16%+/-0.07 for 12 mm wedge. The posterior translation of the posterior calcaneus segment was 9.85%+/-0.09 for 6 mm wedge, 13.15%+/-0.09 for 8 mm wedge, 12.04+/-0.09 for 10 mm wedge, and 14.06%+/-0.10 for 12 mm wedge. Statistical analysis showed that: 6 mm wedges did not cause significant changes in the translation of both anterior and posterior calcaneus segments with respect to the talus. 8 mm, 10 mm and 12 mm wedges caused significant translations both anteriorly and posteriorly. There was no statistically significant difference in the amount of either anterior or posterior translation caused by 8 mm, 10 mm or 12 mm wedges. These results were corroborated by 3D measurements. CONCLUSION: Of interest is that a 6 mm graft did not cause any significant anterior or posterior shift of the calcaneus. Lateral column lengthening with the 8,10, and 12 mm grafts however caused forward shifting of the anterior calcaneus, but also statistically significant posterior translation of the tuberosity, causing impingement of the posterior facet which was visible in each cadaver tested. There was no statistical difference between the sizes of the wedge above 6 mm and the translations they caused either anteriorly or posteriorly. Surgeons should be aware of the potential for painful impingement with the lateral column lengthening osteotomy.