Posterior calcaneal osteotomy with wedge: Cadaver testing of a new procedure for insufficiency of the posterior tibial tendon

Insufficiency of the posterior tibial tendon is challenging to treat, When the deformity is flexible, treatment options have included tendon transfer, often combined with a medial slide calcaneal osteotomy and/or a lengthenin g of the lateral column. Posterior calcaneal osteotomy has been shown to gi ve correction, although not full correction. Lengthening of the lateral col umn also has been shown to give correction and has been used in the more se vere flexible deformities, but it involves either fusion of the calcaneocub oid joint or risk of arthritis at this joint. An osteotomy combining the calcaneal medial slide with a lengthening of the lateral column at the same osteotomy site has been tested in the laborator y. This combined osteotomy provides a lengthening of the lateral column, bu t it is positioned away from the calcaneocuboid joint. In this study, the o steotomy was compared with a medial slide calcaneal osteotomy and an Evans lengthening of the lateral column, using a cadaver flatfoot model. Radiogra phic measurements were made to evaluate correction of the planovalgus defor mity after each of these procedures. There was statistically significant im proved correction with the new osteotomy compared with that in a standard m edial slide, and correction was comparable to that in the lengthening of th e lateral column. This combined osteotomy may be a reasonable alternative w hen more correction is desired than can be obtained from a medial slide alo ne and when the surgeon wishes to avoid an osteotomy near the calcaneocuboi d joint.