title: The contribution of medializing calcaneal osteotomy on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity.
abstract: BACKGROUND
  Successful correction of hindfoot alignment in adult acquired flatfoot deformity (AAFD) is likely influenced by the degree of medializing calcaneal osteotomy (MCO) performed, but it is not known if other reconstruction procedures significantly contribute as well. The purpose of this study was to evaluate the correlation between common preoperative and postoperative variables and hindfoot alignment.
  
  
  METHODS
  Thirty patients with stage II AAFD undergoing flatfoot reconstruction were followed prospectively. Preoperative and postoperative radiographs were reviewed to assess for correction in hindfoot alignment as measured by the change in hindfoot moment arm. Nineteen variables were analyzed, including age, gender, height, weight, body mass index (BMI), medial cuneiform-fifth metatarsal height, anteroposterior (AP) talonavicular coverage, AP talus-first metatarsal, lateral talus-first metatarsal and calcaneal pitch angles as well as intraoperative use of the MCO, lateral column lengthening (LCL), Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament reconstruction, and gastrocnemius recession or Achilles lengthening. Mean age was 57.3 years (range, 22-77). Final radiographs were obtained at a mean of 47 weeks (range, 25-78) postoperatively.
  
  
  RESULTS
  Seven variables were found to significantly affect hindfoot moment arm. These were gender (P < .05), the amount of MCO performed (P < .001), LCL (P < .01), first tarsometatarsal fusion (P < .01), spring ligament reconstruction (P < .01), medial cuneiform-fifth metatarsal height (P < .001), and calcaneal pitch angle (P < .05). Multivariate regression analysis revealed that MCO was the only significant predictor of hindfoot moment arm. The final regression model for MCO showed a good fit (R(2) = .93, P < .001).
  
  
  CONCLUSIONS
  Correction of hindfoot valgus alignment obtained in flatfoot reconstruction is primarily determined by the MCO procedure and can be modeled linearly. We believe that the hindfoot alignment view can serve as a valuable preoperative measurement to help surgeons adjust the proper amount of correction intraoperatively.
  
  
  METHODS
  Level IV, prospective case series.
authors: Hospital for Special Surgery, New York, NY, USA.
authors: Jeremy Y
authors: JY
authors: Chan
authors: Benjamin R
authors: BR
authors: Williams
authors: Pallavi
authors: P
authors: Nair
authors: Elizabeth
authors: E
authors: Young
authors: Carolyn
authors: C
authors: Sofka
authors: Jonathan T
authors: JT
authors: Deland
authors: Scott J
authors: SJ
authors: Ellis
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005413:Flatfoot / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D055815:Young Adult