title: Medial displacement calcaneal osteotomy using minimally invasive technique.
abstract: BACKGROUND
  Medial displacement calcaneal osteotomy is a common procedure often used as part of pes planovalgus deformity correction. Traditionally the osteotomy is performed using a direct lateral or extended lateral approach, which may carry the risk of wound problems, infection and neurovascular injury. The authors describe a minimally invasive technique to perform the osteotomy and achieve the desired correction. The article illustrates our experience and learning curve with the use of this technique as an option for calcaneal osteotomy.
  
  
  METHODS
  We retrospectively reviewed the records of a sequential series of patients since 2011 whose calcaneal osteotomies were performed by 2 surgeons, after cadaveric training using a minimally invasive operative approach. Prior to 2011, similar surgeries, performed by the senior authors, were undertaken using a direct lateral approach. Thirty cases were identified; 29 had tibialis posterior reconstruction coupled with calcaneal osteotomy for acquired flexible planovalgus deformity and 1 patient had surgery for a malunited calcaneal fracture.
  
  
  RESULTS
  Radiological and clinical union occurred in all 30 cases (100%). The radiographs of all cases were reviewed by a specialist musculoskeletal radiologist. There were no neurovascular or wound complications. All patients had restoration of neutral hindfoot alignment. One patient required screw removal after union, resolving all symptoms.
  
  
  CONCLUSIONS
  This series suggests that minimally invasive calcaneal osteotomy surgery can achieve excellent union rates aiding correction of deformity with no observed neurovascular or soft tissue complications. For surgeons experienced in open surgery, there is a short learning curve after appropriate training.
authors.affiliation: Department of Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, UK.
authors.forename: Ehab
authors.initials: E
authors.lastname: Kheir
authors.affiliation: Department of Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, UK.
authors.forename: Vishal
authors.initials: V
authors.lastname: Borse
authors.affiliation: Department of Musculoskeletal Radiology, Harrogate and District NHS Foundation Trust, Harrogate, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Sharpe
authors.affiliation: Department of Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, UK.
authors.forename: David
authors.initials: D
authors.lastname: Lavalette
authors.affiliation: Department of Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, UK mark.farndon@hdft.nhs.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Farndon
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies
keywords: calcaneal osteotomy; minimally invasive surgery; percutaneous technique