title: Radiographic outcomes of adult acquired flatfoot corrected by medial column arthrodesis with or without a medializing calcaneal osteotomy.
abstract: Medial column arthrodesis and calcaneal osteotomies are commonly used for adult acquired flatfoot surgical reconstruction. In this retrospective study, 41 patients (47 feet) with a mean age of 55 ± 13.5 years underwent a medial column arthrodesis, with or without calcaneal osteotomy, between 1999 and 2007. The indication for surgery was a painful flatfoot deformity with peritalar subluxation, and a fault in the naviculocuneiform joint. At a mean of 9.6 (range 3-43) months postoperatively, in patients who underwent a medial column arthrodesis, radiographs showed a mean decrease in the talonavicular coverage angle of 10.2° ± 8.7° (P < .001), and mean increases in the lateral talometatarsal and calcaneal inclination angle of 10.7° ± 5.1° (P < .001) and of 3.2° ± 2.7° (P < .001), respectively. In patients who underwent a combined medial column arthrodesis and a medializing calcaneal osteotomy, the talonavicular coverage angle decreased by a mean of 12.1° ± 6.1° (P < .001), while the lateral talometatarsal angle and calcaneal inclination angle increased by a mean of 12.3° ± 6.1° (P < .001) and 3.1° ± 2.7° (P < .001), respectively, from preoperative values. Four nonunions (4 of 47, 8.51%) occurred at the naviculocuneiform joint and 1 nonunion (1 of 32, 3.13%) occurred at the tarsometatarsal joint. These findings demonstrate marked improvement of radiographic flatfoot parameters following a medial column arthrodesis with or without a medializing calcaneal osteotomy.
authors.affiliation: Kaiser Permanente San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Permanente Medical Center, Oakland, CA 94611, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Jordan
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rush
authors.forename: Graham A
authors.initials: GA
authors.lastname: Hamilton
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D002111:Calcaneus / Q000601:surgery*; D015331:Cohort Studies; D005413:Flatfoot / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010027:Osteotomy; D011859:Radiography; D012189:Retrospective Studies; D013709:Tendon Transfer; D013710:Tendons / Q000601:surgery; D055815:Young Adult