title: Neurologic Deficit Associated With Lateralizing Calcaneal Osteotomy for Cavovarus Foot Correction.
abstract: BACKGROUND
  Lateralizing calcaneal osteotomy (LCO) is a frequently used technique to correct hindfoot varus deformity. Tibial nerve palsy following this osteotomy has been described in case reports but the incidence has not been quantified.
  
  
  METHODS
  Eighty feet in 72 patients with cavovarus foot deformity were treated over a 6-year span by 2 surgeons at their respective institutions. Variations of the LCO were employed for correction per surgeon choice. A retrospective chart review analyzed osteotomy type, osteotomy location, amount of translation, and addition of a tarsal tunnel release in relation to the presence of any postoperative tibial nerve palsy. Tibial nerve branches affected and the time to resolution of any deficits was also noted.
  
  
  RESULTS
  The incidence of neurologic deficit following LCO was 34%. With an average follow-up of 19 months, a majority (59%) resolved fully at an average of 3 months. There was a correlation between the development of neurologic deficit and the location of the osteotomy in the middle third as compared to the posterior third of the calcaneal tuber. We found no relationship between the osteotomy type, amount of correction, or addition of a tarsal tunnel release and the incidence of neurologic injury.
  
  
  CONCLUSIONS
  Tibial nerve palsy was not uncommon following LCO. Despite the fact that deficits were found to be transient, physicians should be more aware of this potential problem and counsel patients accordingly. To decrease the risk of this complication, we advocate extra caution when performing the osteotomy in the middle one-third of the calcaneal tuberosity. Although intuitively the addition of a tarsal tunnel release may protect against injury, no protective effect was demonstrated in this retrospective study.
  
  
  METHODS
  Level III, retrospective cohort study.
authors.affiliation: Upstate Bone and Joint Center, East Syracuse, NY, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: VanValkenburg
authors.affiliation: The Warren Alpert School of Medicine of Brown University and Rhode Island Hospital, Providence, RI, USA raymond_hsu@brown.edu.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Hsu
authors.affiliation: Des Moines Orthopaedic Surgeons, West Des Moines, IA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Palmer
authors.affiliation: The Warren Alpert School of Medicine of Brown University and Rhode Island Hospital, Providence, RI, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Blankenhorn
authors.affiliation: Des Moines Orthopaedic Surgeons, West Des Moines, IA, USA.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Den Hartog
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: DiGiovanni
mesh_terms: D002111:Calcaneus / Q000601:surgery*; D005260:Female; D005530:Foot Deformities / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D010243:Paralysis / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013979:Tibial Nerve / Q000293:injuries; D020429:Tibial Neuropathy / Q000209:etiology*
keywords: cavovarus deformity; lateralizing calcaneal osteotomy; tibial nerve palsy