title: Posterior calcaneal displacement osteotomy for adult acquired flatfoot.
abstract: The authors retrospectively reviewed 24 patients who underwent posterior calcaneal displacement osteotomy (PCDO) for posterior tibial tendon dysfunction and adult acquired flatfoot deformity from 1991 to 1996. The average follow-up was 27 months. Analysis consisted of preoperative and postoperative evaluation of radiographs, as well as postoperative subjective results. Ancillary procedures included flexor digitorum longus tendon transfer (n = 19), tendo Achilles lengthening (n = 21), tibialis anterior tendon transfer (n = 5), naviculocuneiform joint arthrodesis (n = 4), and first metatarsocunieform joint arthrodesis (n = 1). The talo-first metatarsal angle on the lateral view decreased from a preoperative average of 22.13 degrees to a postoperative average of 8.50 degrees. The talo-first metatarsal angle on the anteroposterior view decreased from an average preoperative value of 22.96 degrees to a postoperative average of 11.04 degrees. In all cases, talar head coverage at the talonavicular joint improved. Subjective results were categorized as good (n = 17), satisfactory (n = 5), and poor (n = 2). Complications included sural neuritis (n = 6), Achilles tendon rupture (n = 2), difficulty with fixation (n = 2), and undercorrection of deformity (n = 2). Patients who had higher preoperative and postoperative talo-first metatarsal angles on either the anteroposterior or lateral radiographs had significantly poorer outcomes (p = .0403, p = .002, p = .009, p = .001, respectively). In addition, those patients who had medial column fusions had statistically significant poorer subjective results (p = .015). Patients who had flexor digitorum longus (FDL) tendon transfers did significantly better than those patients who did not have FDL transfer (p = .004). The authors conclude that the posterior calcaneal displacement osteotomy is a reasonable option for management of posterior tibial tendon dysfunction in the adult acquired flatfoot.
authors.affiliation: Department of Surgery, The Western Pennsylvania Hospital, Pittsburgh, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Catanzariti
authors.forename: M S
authors.initials: MS
authors.lastname: Lee
authors.forename: R W
authors.initials: RW
authors.lastname: Mendicino
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005413:Flatfoot / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000145:classification / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013709:Tendon Transfer; D013710:Tendons / Q000503:physiopathology / Q000601:surgery