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The Journal of Bone and Joint Surgery, Vol 77, Issue 4 500-512, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot
VS Mosca
Department of Orthopedics, Children's Hospital and Medical Center, Seattle, Washington 98105, USA.
Thirty-one severe, symptomatic valgus deformities of the hindfoot in twenty
children who had flatfoot (twenty-five feet) or skewfoot (six feet) were
corrected with a modification of the calcaneal lengthening osteotomy
described by Evans. Despite prolonged non-operative treatment, all patients
had pain, a callus, ulceration, or a combination of these signs and
symptoms under the head of the plantar flexed talus; they could not
tolerate a brace, and shoe wear was excessive. Twenty-six of the
deformities were secondary to an underlying neuromuscular disorder. The
calcaneal lengthening was combined with an opening-wedge osteotomy of the
medial cuneiform to correct the deformities of both the hindfoot and the
forefoot in the patients who had a skewfoot. Other concurrent osseous and
soft-tissue procedures were frequently performed in the flatfeet and
skewfeet to correct adjacent deformities or to balance the muscle forces.
Allograft bone was used in twenty-four feet and autogenous bone, in seven.
The patients ranged in age from four years and seven months to sixteen
years at the time of the operation. The duration of follow-up ranged from
two years to three years and seven months after the operation. Satisfactory
clinical and radiographic correction of all components of the deformity of
the hindfoot was achieved in all but the two most severely deformed feet.
These two feet had sufficient correction to eliminate the symptoms despite
a small persistent callus under the head of the talus. The pain and callus
were eliminated in all of the other feet, the patients were able to
tolerate a brace, and shoe wear was improved. Subtalar motion was preserved
in all feet except for the four that had had a limited joint arthrodesis
performed previously or simultaneously for pre-existing degenerative
osteoarthrosis. Calcaneal lengthening is effective for the correction of
severe, intractably symptomatic valgus deformities of the hindfoot in
children. My patients had resolution of the signs and symptoms associated
with the deformity while avoiding the need for an arthrodesis and the many
short and long-term complications associated with it.
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