CME OnDemand: 2022 AOFAS Annual Meeting-Talar Head Coverage Correction in the Absence of Lateral Column Lengthening: A Prospective Study with Calcaneal Osteotomy and First Ray Procedures

Talar Head Coverage Correction in the Absence of Lateral Column Lengthening: A Prospective Study with Calcaneal Osteotomy and First Ray Procedures

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This study aimed to investigate the effectiveness of the Lapidus and the Cotton procedures in combination with a calcaneus displacement osteotomy (MDCO) in improving midfoot abduction in patients with a collapsed foot. The hypothesis was that these first ray procedures would correct midfoot abduction without the need for lateral column lengthening. <br /><br />A total of 20 patients were included in the study, with 11 having Progressive Collapsing Foot Deformity (PCFD) and 9 having Hallux Valgus (HV). Bone block Lapidus was performed in most subjects, and MDCO occurred in 55% of patients. <br /><br />The results showed improvement in all measured variables, including the talonavicular coverage angle (TNCA), forefoot arch angle (FFA), and talus-first metatarsal angle (TFMA). There was a correlation between TNCA improvement and FFA improvement, but not between TNCA improvement and TFMA improvement. <br /><br />The size of the wedge used in MDCO did not strongly influence TNCA correction, while the amount of displacement moderately explained the improvement. <br /><br />The study concluded that midfoot abduction can be corrected without the need for lateral column lengthening in patients with a collapsed foot. The combination of first ray procedures and MDCO resulted in an improvement in talar head coverage. The variables associated with arch height and forefoot varus were correlated with TNCA improvement, and the displacement amount in MDCO was a significant factor in the changes observed. <br /><br />The findings of this study may assist surgeons in planning treatment for patients with Progressive Collapsing Foot Deformity.

Asset Subtitle

Nacime SB Mansur, MD, Kepler Carvalho, MD, Eli Schmidt, Ki Chun Kim, MD, Edward O. Rojas, MD, Vineel Mallavarapu, BS, Kevin N. Dibbern, PhD, Jonathan T. Deland, MD, Matthieu Lalevée, MD, Cesar De Cesar Netto, MD, PhD

Keywords

Lapidus procedure

Cotton procedure

calcaneus displacement osteotomy

midfoot abduction

collapsed foot

Progressive Collapsing Foot Deformity

Hallux Valgus

talonavicular coverage angle

forefoot arch angle

surgical treatment