title: Double calcaneal osteotomy with percutaneous Steinmann pin fixation as part of treatment for flexible flatfoot deformity: a review of consecutive cases highlighting our experience with pin fixation.
abstract: Surgical correction of flexible flatfoot deformity and posterior tibial tendon dysfunction has been extensively reported in published studies. When appropriate, calcaneal osteotomies for flatfoot correction have been a favorite of foot and ankle surgeons because of the corrective power achieved without the need to fuse any rearfoot joints. The medial displacement calcaneal osteotomy and Evans calcaneal osteotomy, together termed the double calcaneal osteotomy, have been reported several times by various investigators with a wide variety of fixation options. We undertook an institutional review board-approved retrospective review of 9 consecutive patients (11 feet), who had undergone double calcaneal osteotomy with 2 percutaneous Steinmann pin fixation for the correction of flexible flatfoot deformity, with or without posterior tibial tendon dysfunction. All patients had radiographic evidence of bone healing of the posterior calcaneal osteotomy and incorporation of the Evans osteotomy bone graft at 6 weeks and demonstrated clinical healing at 6 weeks. All patients had 2 percutaneous Steinmann pins placed through both osteotomies, and these were removed an average of 6 weeks postoperatively. No patient developed pin site complications. The only complication noted was sural neuritis, which was likely incision related. No patients had delayed union or nonunion, and we did not identify any graft shifting postoperatively. The present retrospective series highlights our experience with 2 percutaneous Steinmann pin fixation, demonstrating equal or better results than many previous published fixation methods for double calcaneal osteotomy. It is cost-effective and minimizes the potential risk of iatrogenic Achilles pathologic features associated with screw fixation.
authors.affiliation: Director, Foot and Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St Paul, MN.
authors.forename: Troy J
authors.initials: TJ
authors.lastname: Boffeli
authors.affiliation: Chief Resident, Department of Foot and Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, St Paul, MN. Electronic address: kyle.w.abben@healthpartners.com.
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Abben
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery*; D002648:Child; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Achilles tendon; Evans osteotomy; calcaneus; posterior tibial tendon dysfunction; sural nerve