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Effects of lateral column lengthening for flat foot
A biomechanical analysis of the effect of lateral column lengthening calcaneal osteotomy on the flat foot.
Arangio GA, Chopra V, Voloshin A, Salathe EP. Clin Biomech (Bristol, Avon). 2007 Jan 6
Quote:
BACKGROUND: Biomechanical models have been used to study the plantar aponeurosis, medial arch height, subtalar motion, medial displacement calcaneal osteotomy, subtalar arthroereisis and the distribution of forces in the normal and flat foot. The objective was to examine the hypothesis that increased load on the medial arch in the adult flat foot can be reduced through a 10mm lateral column lengthening calcaneal osteotomy 10mm proximal from the calcaneal cuboid joint.
METHODS: A three dimensional multisegment biomechanical model was used with anatomical data from a normal foot, a flat foot and a foot corrected with a 10mm lateral column lengthening calcaneal osteotomy. The response of a normal foot, a flat foot and a flat foot with a 10mm lateral column lengthening calcaneal osteotomy to an applied load of 683N was analyzed using the biomechanical model. Data for the biomechanical model was obtained from a cadaver foot using the direct linear transformation method. Direct linear transformation uses multiple cameras to determine the spatial location of anatomical landmarks.
FINDINGS: Load on the first metatarsal increases to 37% body weight in the flat foot compared to 12% for the normal foot and the moment about the talo-navicular joint increases from 5.6Nm to 21.6Nm. Lateral column lengthening shifts the load toward the lateral column, decreasing load on the first metatarsal to 10% and decreasing the moment about the talo-navicular joint to 8.1Nm.
INTERPRETATION: The analysis shows that a 10mm lateral column lengthening calcaneal osteotomy reduces the excess force on the medial arch in an adult flat foot and adds biomechanical rationale to this clinical procedure.
Re: Effects of lateral column lengthening for flat foot
Lateral column calcaneal lengthening, flexor digitorum longus transfer, and opening wedge medial cuneiform osteotomy for flexible flatfoot: a biomechanical study. Foot Ankle Int. 2007 Jan;28(1):70-7.
Benthien RA, Parks BG, Guyton GP, Schon LC.
Quote:
BACKGROUND: Lengthening of the lateral column is commonly used for reconstruction of the adult and pediatric flatfoot, but can result in supination of the foot and symptomatic lateral column overload. The addition of a medial cuneiform osteotomy has been used to redistribute forces to the medial column. The combined use of a lateral column lengthening and medial cuneiform osteotomy in a reproducible cadaver flatfoot model was evaluated.
METHODS: Twelve cadaver specimens were physiologically loaded and each was evaluated radiographically and pedobarographically in the following conditions: 1) intact, 2) severe flatfoot, 3) lateral column lengthening with simulated flexor digitorum longus transfer, and 4) lateral column lengthening and flexor digitorum longus (FDL) transfer with added medial cuneiform osteotomy. The lateral column lengthening was performed with a 10-mm foam bone wedge through the anterior process of the calcaneus, and the medial cuneiform osteotomy was performed with a dorsally placed 6-mm wedge.
RESULTS: Lateral column lengthening with simulated FDL transfer on a severe flatfoot model resulted in a significant change as compared with the flatfoot deformity in three measurements: in lateral talus-first metatarsal angle (-17 to -7 degrees; p < 0.001), talonavicular angle (46 to 24 degrees; p < 0.001), and medial cuneiform height (16 to 20 mm; p < 0.001). Lateral forefoot pressure increased from 24.6 to 33.9 kPa (p < 0.001) after these corrections as compared with the flatfoot. Adding a medial cuneiform osteotomy decreased the lateral talar-first metatarsal angle from -7 to -4 degrees, decreased the talonavicular coverage angle from 24 to 20 degrees, and increased the medial cuneiform height from 20 to 25 mm. After added medial cuneiform osteotomy, lateral pressure was significantly different from that of the flatfoot (p = 0.01) and was not significantly different from that of the intact foot (p = 0.14). Medial forefoot pressure was overcorrected as compared with the intact foot with added medial cuneiform osteotomy.
CONCLUSIONS: Lateral column lengthening increased lateral forefoot pressures in a severe flatfoot model. An added medial cuneiform osteotomy provided increased deformity correction and decreased pressure under the lateral forefoot.
Re: Effects of lateral column lengthening for flat foot
A comparison of lateral column lengthening and medial translational osteotomy of the calcaneus for the reconstruction of adult acquired flatfoot.
Bolt PM, Coy S, Toolan BC. Foot Ankle Int. 2007 Nov;28(11):1115-23.
Quote:
BACKGROUND: This study compared the effects of lateral column lengthening and medial translational calcaneal osteotomy on pedal realignment and degeneration of adjacent hindfoot joints noted on radiographs.
METHODS: Forty patients who had either a lateral column lengthening (25 feet) or calcaneal osteotomy (17 feet) to reconstruct a flatfoot were retrospectively reviewed as two groups. Six parameters of foot alignment were measured from weightbearing preoperative, early postoperative, and latest followup radiographs. The magnitude of realignment achieved initially and preserved at latest followup was determined for each group. The talonavicular and subtalar joints were graded for radiographic evidence of arthritis before the reconstruction and at latest followup. Demographic information, complication rate, and reoperation associated with each group also were determined by chart review.
RESULTS: The group that received a lateral column lengthening demonstrated a greater initial realignment than the group treated with a calcaneal osteotomy. The lengthening group also demonstrated greater realignment than the osteotomized group when they were compared at their respective latest followup. The lengthening group had a higher number of adjacent joints with progression of arthritis. The rate of nonunion was higher with a lateral column lengthening; however, the rate of reoperation after an osteotomy was more than twice that observed after a lateral column lengthening.
CONCLUSIONS: The lateral column lengthening group achieved greater realignment initially and maintained correction better over time than the calcaneal osteotomy group while having a lower reoperation rate despite a higher incidence of nonunion and radiographic progression of adjacent joint arthritis.
Effects of lateral column lengthening for flat foot
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