Optimal position of the calcaneus after surgical correction of posttraumatic hindfoot deformity

Introduction. Medializing osteotomy of the calcaneus is vastly used by an orthopedic society in practice as part of the surgical correction of valgus deformity of the calcaneus, which is observed in patients mainly with acquired flatfoot. However, acquired flatfoot in adults often has a similar clinical picture to post-traumatic valgus deformity of the calcaneus, which makes it possible to use medializing osteotomy of the calcaneus for deformities of various origins.

Aim: to improve the results of treatment of patients with post-traumatic valgus deformity of the calcaneus.

Materials and methods. Retrospective non-randomized study. Using the method of copying from medical records, a sample of 55 patients with post-traumatic valgus deformity of the calcaneus, who underwent medializing calcaneal osteotomy (MCO) from January 2012 to December 2020, was formed. At the follow-up examination, a physical examination, identification of complaints, assessment of pain, function and radiographs were performed. In order to objectively assess the results, the FAOS questionnaire was used.

Statistical processing. The results were recorded in a Microsoft Excel 2007 table. Quantitative indicators are presented as the average value of the indicator and its standard deviation, qualitative indicators - as the percentage of occurrence of the characteristic. Statistical processing was carried out using the IBM SPSS STATISTICA 23.0 program. To assess the significance of the results among independent groups after surgery, the Kraskes-Wallis test was used, and in the groups before and after surgery, the Wilcoxon test was used.

Results. The patients were conditionally divided into 3 groups depending on the postoperative angle of deformation of the calcaneus at the control examination: group 1 “valgus” (angle >0 degrees; n=18); Group 2 “moderate varus” (0<angle<5 degrees; n=17); Group 3 “varus” (angle>5 degrees; n=20). The groups were comparable to each other according to these characteristics (p<0.05). The average age of the patients was 49.6±4.6. The average follow-up period was 23.5±8.7 months. Average BMI 28.6±3.2. In all groups, according to the FAOS questionnaire, statistically significantly (p<0.05) better results were obtained at the follow-up examination than before surgery. Statistically significant differences in postoperative results between groups according to the FAOS questionnaire based on the assessment of the “pain” and “other symptoms” subscales were obtained in the “moderate varus” group. In the “other symptoms” subscale of the FAOS, the mean change in scores for the “varus” group (n = 19) was 6.6 (range -40.7 to 46.4), for the “moderate varus” group (n = 16) was 25.9 (range 3.6 to 78.6) and 11.0 (range -32.1 to 46.4) for the valgus group (n= 18). The average change in the “pain” subscale according to FAOS for the “varus” group (n=16) was 27.9 (range from -8.3 to 63.9), for the “moderate varus” group (n=17) was 41.2 (range from 5.6 to 66.7) and for the “valgus deformity” group (n=18) was 22.3 (range from -58.3 to 63.9).

Discussion. The “moderate varus” position of the calcaneus was found to be the most functional.

Conclusions. The use of MCO in patients with post-traumatic valgus deviation of the calcaneus shows optimal results and deserves wider use in this cohort of patients. However, the result can be improved by intraoperatively placing the calcaneus in a moderate varus position.

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