title: The contribution of the medial calcaneal osteotomy to the correction of flatfoot deformities.
abstract: OBJECTIVE
  The success of the medial displacement calcaneal osteotomy in correcting flatfoot deformities is likely to be the result of a shift of the Achilles tendon forces on the hindfoot. The purpose of this study was twofold: 1) to define the contribution of the Achilles tendon to the flatfoot deformity, and 2) to define the effect of a calcaneal medial displacement osteotomy.
  
  
  METHODS
  We used six different experimental dynamic stages: 1) intact foot without Achilles loading; 2) intact foot with Achilles loading; 3) flatfoot without medial calcaneal displacement osteotomy and without Achilles loading; 4) flatfoot without medial calcaneal displacement osteotomy but with Achilles loading; 5) flatfoot with medial calcaneal displacement osteotomy but without Achilles loading; and 6) flatfoot with medial calcaneal displacement osteotomy and with Achilles loading. The experimental flaffoot was developed by releasing the posterior tibial tendon, spring ligament, and plantar fascia and applying 7,000 cycles of axial fatigue load (range, 700 to 1,400 N; 1-Hz frequency). To simulate the phase of midstance, the peroneus longus, peroneus brevis, flexor digitorum longus, and flexor hallucis longus tendons were grasped by clamps, connected to pneumatic actuators, and loaded with precalculated forces. Anteroposterior and lateral radiographs were obtained for each stage on which the following measurements were made: talonavicular coverage angle, talar-first metatarsal angle, talocalcaneal angle, and height of the medial cuneiform. These measurements were compared with a one-way ANOVA.
  
  
  RESULTS
  Between stages 1 and 2, all measurements were statistically insignificant. Between stages 3 and 4, for all measurements, Achilles tendon loading aggravated the flatfoot deformity (p < 0.05). After medial calcaneal osteotomy (stages 5 and 6), the Achilles tendon contributed less to the arch-flattening. We found that the medial displacement osteotomy plays an important role in reducing and/or delaying the progress of flatfoot deformity.
  
  
  CONCLUSIONS
  In the flatfoot, loading of the Achilles tendon increases the deformity. Medial calcaneal osteotomy significantly decreases the arch-flattening effect of this tendon and therefore limits the potential increase of the deformity.
authors.affiliation: Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Nyska
authors.forename: B G
authors.initials: BG
authors.lastname: Parks
authors.forename: I T
authors.initials: IT
authors.lastname: Chu
authors.forename: M S
authors.initials: MS
authors.lastname: Myerson
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology; D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D002111:Calcaneus / Q000601:surgery*; D005413:Flatfoot / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005529:Foot Bones / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D010027:Osteotomy / Q000379:methods*; D013710:Tendons / Q000503:physiopathology