Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHANG Lin ,  WANG Xiangyu , WANG Aiguo , JIA Guanghui , LI Qi , ZHANG Xiaolong , MA Fuqiang , WANG Yalei

Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou Henan, 450052, P.R.China;

Corresponding author：

WANG Xiangyu, Email: 920354911@qq.com

Keywords：

Talocalcaneal coalition; Evans lateral lengthening calcaneal osteotomy; valgus deformity; foot

DOI：

10.7507/1002-1892.201907065

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Objective To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity.Methods Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation.Results All incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores (t=−23.380, P=0.000; t=35.218, P=0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones (P<0.05), and the CP was significantly higher than preoperative one (P<0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot).Conclusion For TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain.

Citation： SHANG Lin, WANG Xiangyu, WANG Aiguo, JIA Guanghui, LI Qi, ZHANG Xiaolong, MA Fuqiang, WANG Yalei. Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 173-178. doi: 10.7507/1002-1892.201907065 Copy

1.	Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res, 2014, 9: 129-137.
2.	Aldahshan W, Hamed A, Elsherief F, et al. Endoscopic resection of different types of talocalcaneal coalition. Foot Ankle Int, 2018, 39(9): 1082-1088.
3.	Farid A, Faber FWM. Bilateral triple talocalcaneal, calcaneonavicular, and talonavicular tarsal coalition: A case report. J Foot Ankle Surg, 2019, 58(2): 374-376.
4.	Luhmann SJ, Schoenecker PL. Symptomatic talocalcaneal coalition resection: indications and results. J Pediatr Orthop, 1998, 18(6): 748-754.
5.	Lyon R, Liu XC, Cho SJ. Effects of tarsal coalition resection on dynamic plantar pressures and electromyography of lower extremity muscles. J Foot Ankle Surg, 2005, 44(4): 252-258.
6.	Wilde PH, Torode IP, Dickens DR, et al. Resection for symptomatic talocalcaneal coalition. J Bone Joint Surg (Br), 1994, 76(5): 797-801.
7.	Mosca VS, Bevan WP. Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. J Bone Joint Surg (Am), 2012, 94(17): 1584-1594.
8.	Murphy JS, Mubarak SJ. Talocalcaneal coalitions. Foot Ankle Clin, 2015, 20(4): 681-691.
9.	Klammer G, Espinosa N, Iselin LD. Coalitions of the tarsal bones. Foot Ankle Clin, 2018, 23(3): 435-449.
10.	Gougoulias N, O’Flaherty M, Sakellariou A. Taking out the tarsal coalition was easy: but now the foot is even flatter. What now? Foot Ankle Clin, 2014, 19(3): 555-568.
11.	Giannini S, Ceccarelli F, Vannini F, et al. Operative treatment of flatfoot with talocalcaneal coalition. Clin Orthop Relat Res, 2003, (411): 178-187.
12.	Suh DH, Park JH, Lee SH, et al. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. Int Orthop, 2019, 43(5): 1179-1192.
13.	魏民, 刘洋, 魏钰. 关节镜治疗距下关节创伤性关节炎的临床疗效观察. 中国修复重建外科杂志, 2017, 31(2): 150-154.
14.	Yildiz KL, Misir A, Kizkapan TB, et al. Functional and radiological outcomes after tarsal coalition resections: A minimum 5-year follow-up. J Foot Ankle Surg, 2019, 58(6): 1223-1228.
15.	Ettinger S, Mattinger T, Stukenborg-Colsman C, et al. Outcomes of Evans versus Hintermann calcaneal lengthening osteotomy for flexible flatfoot. Foot Ankle Int, 2019, 40(6): 661-671.
16.	Javier Masquijo J, Vazquez I, Allende V, et al. Surgical reconstruction for talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop, 2017, 37(4): 293-297.
17.	Jara ME. Evans osteotomy complications. Foot Ankle Clin, 2017, 22(3): 573-585.
18.	Xu Y, Cao YX, Li XC, et al. Double calcaneal osteotomy for severe adolescent flexible flatfoot reconstruction. J Orthop Surg Res, 2017, 12(1): 153.

1. Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res, 2014, 9: 129-137.
2. Aldahshan W, Hamed A, Elsherief F, et al. Endoscopic resection of different types of talocalcaneal coalition. Foot Ankle Int, 2018, 39(9): 1082-1088.
3. Farid A, Faber FWM. Bilateral triple talocalcaneal, calcaneonavicular, and talonavicular tarsal coalition: A case report. J Foot Ankle Surg, 2019, 58(2): 374-376.
4. Luhmann SJ, Schoenecker PL. Symptomatic talocalcaneal coalition resection: indications and results. J Pediatr Orthop, 1998, 18(6): 748-754.
5. Lyon R, Liu XC, Cho SJ. Effects of tarsal coalition resection on dynamic plantar pressures and electromyography of lower extremity muscles. J Foot Ankle Surg, 2005, 44(4): 252-258.
6. Wilde PH, Torode IP, Dickens DR, et al. Resection for symptomatic talocalcaneal coalition. J Bone Joint Surg (Br), 1994, 76(5): 797-801.
7. Mosca VS, Bevan WP. Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. J Bone Joint Surg (Am), 2012, 94(17): 1584-1594.
8. Murphy JS, Mubarak SJ. Talocalcaneal coalitions. Foot Ankle Clin, 2015, 20(4): 681-691.
9. Klammer G, Espinosa N, Iselin LD. Coalitions of the tarsal bones. Foot Ankle Clin, 2018, 23(3): 435-449.
10. Gougoulias N, O’Flaherty M, Sakellariou A. Taking out the tarsal coalition was easy: but now the foot is even flatter. What now? Foot Ankle Clin, 2014, 19(3): 555-568.
11. Giannini S, Ceccarelli F, Vannini F, et al. Operative treatment of flatfoot with talocalcaneal coalition. Clin Orthop Relat Res, 2003, (411): 178-187.
12. Suh DH, Park JH, Lee SH, et al. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. Int Orthop, 2019, 43(5): 1179-1192.
13. 魏民, 刘洋, 魏钰. 关节镜治疗距下关节创伤性关节炎的临床疗效观察. 中国修复重建外科杂志, 2017, 31(2): 150-154.
14. Yildiz KL, Misir A, Kizkapan TB, et al. Functional and radiological outcomes after tarsal coalition resections: A minimum 5-year follow-up. J Foot Ankle Surg, 2019, 58(6): 1223-1228.
15. Ettinger S, Mattinger T, Stukenborg-Colsman C, et al. Outcomes of Evans versus Hintermann calcaneal lengthening osteotomy for flexible flatfoot. Foot Ankle Int, 2019, 40(6): 661-671.
16. Javier Masquijo J, Vazquez I, Allende V, et al. Surgical reconstruction for talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop, 2017, 37(4): 293-297.
17. Jara ME. Evans osteotomy complications. Foot Ankle Clin, 2017, 22(3): 573-585.
18. Xu Y, Cao YX, Li XC, et al. Double calcaneal osteotomy for severe adolescent flexible flatfoot reconstruction. J Orthop Surg Res, 2017, 12(1): 153.

Chinese Journal of Reparative and Reconstructive Surgery

Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity

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