Simple technique aids alignment of calcaneal varus deformity

By Liam Davenport, medwireNews Reporter

A novel intraoperative bone wedge resection technique for Dwyer calcaneal osteotomy to correct calcaneal varus deformity is simple, accurate, and reproducible, restoring normal tibia calcaneal alignment, concludes a team of US investigators.

For the study, 17 patients underwent a total of 20 Dwyer calcaneal osteotomies using the technique, which allows accurate bone resection and measurement of degree of correction.

A guidewire was placed perpendicular to the tibial anatomic axis and a second wire placed perpendicular to a distal reference line that was 10 mm medial and parallel to the anatomical axis. The resulting wedge of calcaneal bone was removed and the osteotomy closed, and screws or staples used for fixation.

The mean calcaneal varus deformity was reduced from 25º preoperatively to 7º postoperatively, representing a significant 18º ovarus calcaneal correction. The mean medial translation of the calcaneal bisection line reduced from 14 mm preoperatively to 4 mm postoperatively, again a significant reduction.

On lateral view radiograph, the mean calcaneal inclination reduced from 19º preoperatively to 14º postoperatively, and the mean postoperative dorsal calcaneal translation increased from 0º to 2º. Both of these changes represented a significant difference.

During follow up, the patients spent a mean of 6 weeks' nonweightbearing. It took a total of 10 weeks until the patients achieved full weightbearing in normal shoes.

There were two postoperative complications, representing 10.0% of procedures and 11.7% of patients. One patient, who was diabetic, required surgical debridement for wound dehiscence, while one patient did not have complete deformity correction and required revision calcaneal osteotomy with only lateral translation.

The researchers, led by Bradley Lamm, from Sinai Hospital of Baltimore in Maryland, comment: "It is important to remember that even with the use of this intraoperative technique, careful preoperative evaluation and preoperative planning with axial radiographs and a thorough clinical examination to evaluate the presence of associated deformities are crucial to the success of this procedure."

The research is published in the Journal of Foot and Ankle Surgery.

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