Calcaneal Malunions Management and Types of Surgical Correction

CATEGORY: Hindfoot; Ankle INTRODUCTION/PURPOSE: Number of fractures of the calcaneus amounts to 1-5.7% of all fractures of skeleton bones according to various authors. Moreover, these figures correspond to 50% of all fractures of feet bones. Consequences of calcaneus malunion leads to early disability, arthrosis, pain syndrome, disorder of the entire low extremity axis of motion alongside cosmetic defects and shoe wearing discomfort. Purpose of the study: classification of calcaneal malunions based on a geometrically normal position and dimensions of hindfoot in order to develop optimal type of treatment for multicomponent calcaneal deformity. METHODS: Twelve patients with post traumatic deformed hindfoot after malunited calcaneal fractures and as a result varus and valgus deformity, subtalar arthritis, pain syndrome, shoe wear discomfort at different stages after trauma (from 1 to 10 years) were examined, underwent surgical alignment of calcaneus and were followed up for 24 months. All cases were assessed clinically using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring hindfoot varus/valgus, talus tilt, Meary's angle, and hight of calcaneal. RESULTS: It was found a significant improvement in AOFAS (55.2 preoperatively to 78.8 after 24 months) and VAS (65 preoperatively to 30.1). Moreover, our study revealed a significant improvement in the radiographic measurements including hindfoot varus/valgus, the talar inclination, Meary's angle, and hight of calcaneus. CONCLUSION: The elimination of angular hindfoot varus or valgus deformation, exostectomy of the lateral wall and subtalar fusion, as well as the use of a tricortical autograft for distarction arthrodesis at III-V type Zwipp and Rammelt classification, resulted in reduced pain, improved function, cosmetic results and shoe wearing.