gms | German Medical Science

Objective: Calcaneal lengthening as a single procedure to correct severe planovalgus deformity has certain dose-related disadvantages that are discussed in the recent literature.

Methods: A joint preserving combination of tarsal osteotomies for correction of severe planovalgus deformity in adolescents is presented: Slight calcaneal lengthening (6 to 8 mm), medial calcaneal slide osteotomy and an open wedge medial cuneiforme osteotomy, performed as "tarsal triple osteotomy" (TTO) as routinely used combination in 20 cases so far. The first ten of these cases could be evaluated clinically, radiologically and by pre- and postoperative pedographic examination after 30,7 months in the average.

Results and Conclusion: The overall clinical and subjective results were encouraging with high patient satisfaction without any major complications or complaints. Radiologic TMT-index as a biplanar measure of planovalgus deformity was reduced from -47° to -23,7° which is not far from normal adult feet. Load distribution significantly shifted from the medial to central metatarsal rays without unfavourable complete deloading of the medial ray or lateral pressure peaks as were observed in isolated calcaneal lengthening with higher amounts of lateral column-lengthening earlier. An increase of maximum force (10,6%) and of force time integral (18,8%) of the forefoot was found although gastrocnemius-recession was added in all cases.

TTO allows sufficient three-dimensional correction of severe planovalgus deformity in adolescence by three complementary osteotomies. The results may be superior in comparison to isolated calcaneal lengthening especially in terms of a more physiologic load distribution around the midfoot. Some of the reported disadvantages of isolated calcaneal lengthening may be ruled out thereby.