Comparison pre- and post-operative alignment correction in patients with stage II flatfoot deformities treated with bony realignment procedure 1,2 Chamnanni Rungprai, M.D. Co-authors 1 Tyler G. Slayman, B.S.; 1 John E. Femino, M.D.; 1 Annunziato Amendola, M.D.; 1 Phinit Phisitkul, M.D. AOFAS 2015 Annual Meeting ePoster 1.University Of Iowa Hospital and Clinic, Iowa, USA 2.Phramongkutklao hospital and college of medicine, Bangkok, Thailand
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Comparison pre- and post-operative alignment correction in patients with stage II flatfoot deformities treated with bony realignment
procedure
1,2 Chamnanni Rungprai, M.D.
Co-authors 1Tyler G. Slayman, B.S.; 1John E. Femino, M.D.; 1Annunziato Amendola, M.D.; 1Phinit Phisitkul, M.D.
AOFAS 2015 Annual Meeting ePoster
1.University Of Iowa Hospital and Clinic, Iowa, USA 2.Phramongkutklao hospital and college of medicine, Bangkok, Thailand
NO CONFLICT TO DISCLOSE
Comparison pre- and post-operative alignment correction in patients with stage II
flatfoot deformities treated with bony realignment procedure
Chamnanni Rungprai, M.D.
My disclosure is in the Final AOFAS Mobile App.
I have no potential conflicts with this presentation.
is common encounter condition in orthopaedic foot and ankle practice.
AAFD is associated with the tibialis
posterior tendon dysfunction, arthritis, and charcot arthropathy.1,2,8
Diagnosis bases on history, physical
examination, and radiographic assessment.1
Conservative management is the first line
of treatment and if this fails, surgical treatment is indicated.1
Bony realignment procedures such as medial calcaneal slide osteotomy, dorsal opening wedge of the medial cuneiform, lateral column lengthening have been demonstrated to be an effective method for treatment of patients with flatfoot deformities.2-7 However, there is a little evidence in the
previous studies demonstrated the outcomes of foot and ankle angle and alignment.8,9 The purpose of this study was to
compare pre-and post-operative radiographic correction after bony realignment procedures without tendon transfer.
Materials and methods Group 3: 17 patients (19 feet) underwent medial slide calcaneal osteotomy. Group 4: 40 patients (46 feet) underwent EVAN and Cotton. Group 5: 13 patients (13 feet) underwent medial calcaneal slide osteotomy and Cotton. Group 6: 3 patients (3 feet) underwent medial calcaneal slide osteotomy with EVAN. Group 7: 24 patients (26 feet) underwent medial calcaneal slide osteotomy, EVAN, and Cotton.
Retrospective chart review of 113 consecutive patients (124 feet) diagnosed with flatfoot and underwent flatfoot reconstruction using either or combination of gastrocnemius lengthening with dorsal opening wedge of the medial cuneiform (Cotton), medial calcaneal slide osteotomy, and lateral column lengthening (EVAN) between 2008 to 2014. The patients were classified into 7 groups
base on the procedures. Group 1: 11 patients (11 feet) underwent
Cotton. Group 2: 5 patients (5 feet) underwent
EVAN.
Materials and methods Radiographic measurement were
column lengthening (EVAN), and cotton osteotomy, demonstrated improvement of alignment. AP talonavicular coverage 17 to 1
degrees. Calcaneal pitch angle 11 to 21
degrees. Meary angle was -16 to -1 degrees.
Medial cuneiform-fifth metatarsal
height was 2.7 to 9.7 mm. Hindfoot alignment was 9.2 to 0
mm.
Limitations Strengths
Discussion
Retrospective design, and therefore no randomization was used in the methods.
Small number of the patients in EVAN alone and medial calcaneal slide osteotomy with EVAN.
No evaluation of limb rotation in both pre- and post-operative hindfoot alignment measurement as this may lead to errors in the measurement as proposed by Buck et al.10
Consecutive case collection.
Relatively large number of subject.
All surgeries were performed by the same group of fellowship-trained orthopaedic foot and ankle surgeons.
Conclusion All bony realignment procedure demonstrated significant improvement of alignment as measure with radiographic parameters.
For single procedure, EVAN osteotomy is powerful to correct the overall alignment.
The combination of bony procedure is more powerful to correct the deformities and should be considered to treatment of moderate to severe flatfoot deformities.
Reference: 1. Pomeroy GC, Pike RH, Beals TC, Manoli A 2nd. Acquired flatfoot in adults due to dysfunction of the posterior tibial tendon. J Bone Joint Surg Am. 1999 Aug;81(8):1173-82. Review. No abstract available. 2. Backus JD, McCormick JJ. Tendon transfers in the treatment of the adult flatfoot. Foot Ankle Clin. 2014 Mar;19(1):29-48. doi: 10.1016/j.fcl.2013.11.002. Review. 3. Iossi M, Johnson JE, McCormick JJ, Klein SE. Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity. Foot Ankle Int. 2013 Jun;34(6):781-91. doi: 10.1177/1071100713475432. Epub 2013 Feb 5. 4. Richter M, Zech S. Lengthening osteotomy of the calcaneus and flexor digitorum longus tendon transfer in flexible flatfoot deformity improves talo-1st metatarsal-Index, clinical outcome and pedographic parameter. Foot Ankle Surg. 2013 Mar;19(1):56-61. doi: 10.1016/j.fas.2012.10.006. Epub 2012 Dec 7. 5. Niki H, Hirano T, Okada H, Beppu M. Outcome of medial displacement calcaneal osteotomy for correction of adult-acquired flatfoot. Foot Ankle Int. 2012 Nov;33(11):940-6. doi: DOI: 10.3113/FAI.2012.0940. 6. McCormick JJ, Johnson JE. Medial column procedures in the correction of adult acquired flatfoot deformity. Foot Ankle Clin. 2012 Jun;17(2):283-98. doi: 10.1016/j.fcl.2012.03.003. Review. 7. Aronow MS. Tendon transfer options in managing the adult flexible flatfoot. Foot Ankle Clin. 2012 Jun;17(2):205-26, vii. doi: 10.1016/j.fcl.2012.02.001. Epub 2012 Apr 5. Review. 8. Richie DH Jr. Biomechanics and clinical analysis of the adult acquired flatfoot. Clin Podiatr Med Surg. 2007 Oct;24(4):617-44, vii. Review. 9. Zanolli DH, Glisson RR, Nunley JA 2nd, Easley ME. Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model. J Bone Joint Surg Am. 2014 Mar 19;96(6):e45. doi: 10.2106/JBJS.L.00258. 10. Buck FM, Hoffmann A, Mamisch-Saupe N, Espinosa N, Resnick D, Hodler J. Hindfoot alignment measurements: rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs. AJR Am J Roentgenol. 2011 Sep;197(3):578-82. doi: 10.2214/AJR.10.5728.