Lateral column lenghtening by calcaneal osteotomy combined with soft tissue reconstruction for treatment of severe posterior tibial tendon dysfunction. Technique and preliminary results

The purpose of this paper is to present principle and technique of proximal lateral column lengthening by calcaneal osteotomy and to critically analyz e our preliminary results. 16 patients (7 female, 9 male; average age 52.3 years [24-72 years]) were treated for stage II to III posterior tibial tend on insufficiency by calcaneal osteotomy and medial soft tissue reconstructi on (tendon reconstruction, 15; tendon transfer, 8; deltoid ligament repair, 10). When the AOFAS Ankle-Hindfoot Rating Scale was applied, these patient s were shown to have significantly increased their scores from an average p reoperative value of 49.1 to a mean postoperative Value of 91.1 after a mea n follow-up of 24.6 months. In all but one case no loss of achieved foot co rrection was noted. In one case, a fusion of the calcaneocuboid joint had t o be performed after 5 months due to painful degenerative joint disease. At follow-up, all patients had satisfactory restoration of their medial longi tudinal arch, reduction of forefoot abduction, and restored arch height. Al l patients were able to fully weight-bear the operated foot, and all patien ts were satisfied with the achieved result. In the pes planovalgus deformit y occurring in stage II to Ill (as significant degenerative joint disease h as not already occurred), osteotomies appear to have a significant role in the operative management and to function by restoring more normal biomechan ics, thus allowing tendon reconstruction and tendon transfers to return to successfull function.