Evaluation of the anterior and middle talocalcaneal articular facets and the evans osteotomy

doi:10.1016/S1067-2516(02)80085-0

The Journal of Foot and Ankle Surgery

Volume 41, Issue 6, November–December 2002, Pages 389-393

https://doi.org/10.1016/S1067-2516(02)80085-0 Get rights and content

The purpose of this study was to determine the occurrence of discrete anterior and middle talocalcaneal facets and the distance of these facets from the anterior border of the calcaneus as it relates to the Evans osteotomy. Seven hundred sixty-eight calcanei were examined from the human osteology archive at the Cleveland Museum of Natural History. Measurements taken included: 1) distance from the proximal border of the anterior facet to the anterior border of the calcaneus (DTAF), 2) distance from the distal border of the middle facet to the anterior border of the calcaneus (DTMF), and 3) width of facet separation (WFS). The results revealed that 310 of 755 (41.06%) had discrete anterior and middle facets and 423 of 755 (56.03%) had a conjoined facet. In those with discrete facets, the mean DTAF, DTMF, and WFS were 11.04 mm, 15.47 mm, and 3.85 mm, respectively. In those with discrete facets, an osteotomy begun between 11.5 mm and 15 mm from the calcaneocuboid joint should pass between the anterior and middle facets and avoid damaging these articular surfaces. This information may aid the foot and ankle surgeon in patient selection and in attaining optimal surgical outcome for the Evans lateral column lengthening procedure.

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Lateral column lengthening (LCL) using a rectangular shape graft for managing symptomatic flexible flatfoot showed acceptable early functional and radiological outcomes
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Purpose: We aimed to report the results of performing lateral column lengthening (LCL) using a rectangular-shaped graft to correct the flat foot deformity. Methods: A total of 28 feet of 19 patients (10 males, 9 females) having an average age of 10 ± 3.2 years who were unresponsive to conservative management underwent flat foot deformity correction through LCL procedure supplemented with rectangular-shaped graft harvested from the fibula. Functional assessment was performed according to the American Orthopedic Foot and Ankle Society (AOFAS) scale. The radiographic assessment consisted of four parameters, Meary’s angle in both anteroposterior (AP) and lateral (Lat.) views, calcaneal inclination angle (CIA), and calcaneocuboid angle (CCA). Results: After an average of 30.2 ± 8.1 months, the AOFAS improved significantly from 46.7 ± 10.2 preoperatively to 86.7 ± 9.5 at the last follow up (P < 0.05). All the osteotomies showed healing at an average of 10.3 ± 2.7 weeks. All the radiological parameters showed significant improvement at the last follow up compared to the preoperative measurements, CIA from 6.3 ± 2.8–19.3 ± 3.5, Lat. Meary's angle from 19.3 ± 4.9–5.8 ± 2.5, AP Meary’s Angle from 19.3 ± 5.8–6.1 ± 3.1, and CCA from 23.9 ± 8.2–6.8 ± 4.5, (P < 0.05). No pain at the site of the fibular osteotomy was reported in any of the patients. Conclusion: Lateral column lengthening using a rectangular graft effectively restores bony alignment with good radiological and clinical results, high patient satisfaction, and acceptable complications.
Radiographic Analysis of the Lateral Column Lengthening Procedure in Stage II Adult Acquired Flatfoot Deformity
2022, Journal of Foot and Ankle Surgery
Adult acquired flat foot deformity (AAFD) is a progressive, tri-planar deformity involving collapse of the medial longitudinal arch, valgus deformity of the rear foot, and abduction of the mid-foot on the rear foot. There are a wide variety of surgical treatment options for this deformity, including lateral column lengthening (LCL) which results in tri-planar correction of AAFD. We retrospectively reviewed weightbearing preoperative radiographs and weight-bearing 6-week postoperative radiographs of 34 patients with stage II AAFD who underwent LCL (with and without concurrent procedures) with a minimum of 1-year of follow up. Outcomes, including complications and postoperative differences in 6 types of angle measurements were evaluated. Radiographic evaluation showed statistically significant differences in preoperative and postoperative measures in the following angles: calcaneal inclination, Meary's, Simmons, talocalcaneal, and metatarsus adductus (each p ≤ .05). Postoperative Engel's angle difference did not reach statistical significance (p = .07). Paired t tests showed TN coverage angles increased greater with LCL plus a Cotton osteotomy as compared to isolated LCL. Additionally, there was no significant difference in TN coverage angle based on LCL graft size (p = .20). Furthermore, the distance of the osteotomy from the calcaneocuboid joint on anteroposterior and lateral radiographs did not significantly predict TN coverage angle change.
Our study suggests that LCL corrects AAFD in three planes while decreasing the metatarsus adductus angle. LCL appears to be more effective when performed with a Cotton osteotomy. Wedge size (6 mm, 8 mm, 10 mm) and osteotomy location did not demonstrate a relationship with postoperative TN coverage angle or incidence of lateral column overload.
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Citation Excerpt :
We believe that every effort should be made to avoid violation of the anterior and middle facets whenever possible. Although the consequences of intra-articular osteotomies have not been studied yet, they may have potential deleterious effects on the subtalar complex (24–27). We share the beliefs of Ragab et al (24) that joints do accumulate damage over time and that disturbing a congruent subtalar joint may not end favorably later on.
Lateral column lengthening is a common method for treatment of patients with symptomatic flat feet. Although variations of the technique have been described by many authors, there is a lack of agreement about the exact location of the osteotomy. Most authors tried to find the interval between the anterior and middle talocalcaneal facets but did not offer a reproducible method to achieve this purpose. The use of a plantarflexion anteroposterior view of the foot provides better visualization of the anatomic landmarks and helps to precisely perform the osteotomy anterior to the sustentaculum tali, with protection of the anterior and middle talocalcaneal facets.
Postoperative CT-scan 3D reconstruction of the calcaneus following lateral calcaneal lengthening osteotomy for flatfoot deformity in children. Is the surgical procedure potentially associated with subtalar joint damage?
2018, Foot and Ankle Surgery
Citation Excerpt :
However, several anatomical studies have shown that the articular facets of the calcaneus can present with different anatomy. In particular, several cadaveric adult foot studies have found that anterior and middle facets of the calcaneus are joined in 18–78% of cases [9–11]. Attempts to investigate the anatomical relationships between the anterior and middle facet of the calcaneus and the LCL osteotomy are rare [9,10], and none of these studies evaluated the 3D anatomy of the anterior and middle facet of the calcaneus in children undergoing LCL osteotomy for flatfoot deformity correction [3,4].
Several anatomical studies have shown that the articular facets of the calcaneus can present with different anatomy. This study assessed the 3D anatomy of lateral calcaneal lengthening (LCL) osteotomy in relation to the anterior and middle facet of the calcaneus in a group of skeletally immature patients treated for symptomatic flatfoot deformity.
During the study period, 14 consecutive patients (10 males, 4 females) presenting symptomatic flatfoot (20 feet) with different aetiologies underwent LCL osteotomy and CT scan with 3D reconstruction of the operated feet. Anatomy of articular factes of the calcaneus were graded according to Bunning & Barnett’s classification. In order to assess clinical and functional outcome, all patients were evaluated according to Yoo et al.’s, Mosca’s and AOFAS clinical criteria before surgery and at last follow-up visit.
Despite proving difficult to assess (10 out of 20 feet), dimensions of bone and joint structures revealed significant anatomical variations. In particular, working to Bunning & Barnett’s classification, anatomy of the articular facet varied significantly among patients, and in Bunning & Barnett type-B1 or B2 the LCL osteotomy necessarily violates the articular surface of the anterior and middle facet of the calcaneus due to the fact that the two facets are fused together (single articular surface).
These biometric notions allow a better understanding of the impact on articular facets of the calcaneus of the osteotomy procedure suggested by Evans and Mosca. We anticipate that the findings reported here should lead to improved techniques for assessing all bone structures of the hindfoot, support logical classifications of the different pathological situations, and ultimately lead to improved treatment strategies.

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¹: Second Year Resident (RPR/PSR-24).

²: Director, Division of Foot and Ankle Surgery.

³: Director, Podiatric Residency Program; Director of Podiatric Services.

⁴: Clinical Instructor.

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Evaluation of the anterior and middle talocalcaneal articular facets and the evans osteotomy

J. Foot Ankle Surg.

J. Foot Ankle Surg.

Calcaneo-valgus deformity

J. Bone Joint Surg.

The role of calcaneal osteotomies for correction of adult flatfoot

Clin. Orthop.

Treatment of posterior tibial tendon pathology

Foot bones

The lower limb

The lower limb

The lower limb

The lower limb

The lower limb

The lower limb

The lower limb

The lower limb

The lower limb

Bones and joints of the foot

Osteology

Variations in the talocalcaneal articulations

J. Anat.

A comparison of adult and foetal talocalcaneal articulations

J. Anat.

Talar articular facts in human calcanei

Acta Anat.

Variations in the talar articular facets in Egyptian calcanei

Acta Anat.