Lateral Column Lengthening and How to Achieve Good Correction

Lateral column osteotomy versus subtalar arthroereisis in the correction of Grade IIB adult acquired flatfoot deformity: A clinical and radiological follow-up at 24 months

BACKGROUND

Adult acquired flat foot deformity (AAFD) is a spectrum of conditions which can be progressive if untreated. Surgical correction and restoration of anatomical relationship are often required in the treatment of symptomatic Grade II AAFD after a failed course of conservative treatment. There is a paucity of literature recommending best practice-especially in the adult population. The authors aim to compare radiological and clinical outcomes of two widely employed surgical techniques in the treatment of symptomatic AAFD.

METHODS

A retrospective study of 76 patients with Grade IIB AAFD and had undergone either lateral column lengthening (LCL) or subtalar arthroereisis (STA) surgical correction of their symptomatic AAFD. Each technique was augmented with both bony osteotomy and soft tissue transfer as determined by on table assessment. Clinical and radiological outcomes were reviewed 24 months after surgery.

RESULTS

LCL and STA groups had comparable radiological outcomes at 24 months after surgery. However, LCL group demonstrated superior American Orthopaedic Foot and Ankle Society (AOFAS) midfoot (90.3 ± 12.6 vs 81.1 ± 20.6, p < 0.001) as well as Visual Analogue Scale (VAS) midfoot scores (0.5 ± 1.6 vs 1.3 ± 2.4, p < 0.001) at 24 months compared to the STA group. STA had a higher complication rate (20.6% vs 4.4%), with all cases complaining of sinus tarsi pain requiring subsequent removal of implant.

CONCLUSION

There is a role for either techniques in the treatment of symptomatic AAFD. LCL whilst more invasive has demonstrated superior outcome scores and lower complication rates at 24 months compared to STA. Patients need to be counselled appropriately to appreciate the benefits of each technique.

Surgical Management of Symptomatic Adult Pes Planovalgus Secondary to Stage 2B Posterior Tibial Tendon Dysfunction: A Comparison of Two Different Surgical Treatments

BACKGROUND

This study compares radiological and functional outcomes of patients with symptomatic Adult Acquired Flat Foot Deformity (AFFD) secondary to stage 2B Posterior Tibial Tendon Dysfunction (PTTD) treated with either a Subtalar Arthroereisis (SA) implant or a Lateral Column Lengthening (LCL) procedure. The aim of the study is to determine if the Subtalar Arthroereisis procedure is an acceptable surgical adjunct in our treatment armamentarium.

MATERIALS AND METHODS

21 patients (22 feet) were evaluated. 12 consecutive patients (n = 12) underwent a Subtalar Arthroereisis procedure while 9 patients (n = 10) underwent a Lateral Column Lengthening procedure. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Score (AOFAS) midfoot score, Short Form 36 (SF-36) and Visual Analog of Pain Scale (VAS), preoperatively and at 6 and 12 months postoperatively. 10 radiological parameters were analyzed. All complications were tabulated.

RESULTS

Significant improvements in functional outcomes were noted in both groups of patients. Radiographically, some loss of correction was noted in the SA group and no loss of correction in the LCL group, respectively. In the SA group, 6 patients complained of sinus tarsi pain in the postoperative period and 4 required removal of implants. No implants were removed in the LCL group.

CONCLUSION

The results suggest that subtalar arthroereisis may be a reasonable procedure to utilize in the treatment of AAFD, albeit with a relatively high implant-removal rate.