Evans lateral lengthening calcaneal osteotomy for talocalcaneal coalitions with forefoot abduction deformity in the teenagers

Abstract

Objective To evaluate Evans lateral lengthening calcaneal osteotomy(E-LLCOT) in the treatment of talocalcaneal coalitions (TCCs) with forefoot abduction deformity in the teenagers. Methods From February 2014 to August 2018, 11 teenaged patients (14 feet) were treated at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital for TCCs with severe forefoot abduction deformity. They were 6 males (8 feet) and 5 females (6 feet), aged from 13 to 17 years (average, 15 years). Their diseases involved bilateral feet in 3 cases and unilateral foot in 8, the left foot in 7 cases and the right in 7. All patients underwent TCCs resection followed by E-LLCOT. Their talonavicular coverage angles (TCA) and talar-second metatarsal angles (T2-MT) on the anteroposterior film and talar horizontal angles (TH) and talar-first metatarsal angles (T1-MT) on the lateral film were measured preoperatively and at the last follow-up. The foot functions were evaluated preoperatively and at the last follow-up using the ankle- hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Results All the 11 patients were followed up for 12 to 24 months (average, 16.5 months). The mean preoperative TCA (22.3°, from 20° to 26°) was improved to 10.5° (from 8° to 13°) at the last follow-up; the mean T-2MT was improved from preoperative 17.6° (from 16° to 20°) to 6.5° (from 5° to 11°) at the last follow-up; the mean TH on the lateral view was improved from preoperative 35° (from 25° to 40°) to 17.5° (from 16° to 21°) at the last follow-up; the mean T-1MT was improved from preoperative 15.5° (from 10° to 22°) to 3.5° (from 2° to 6°) at the last follow-up; the mean AOFAS score was improved from 56.5 (from 50 to 62) preoperatively to 90.6 (from 75 to 95) at the last follow-up; the mean VAS score was improved from 6.0 (from 5 to 7) preoperatively to 2 (from 0 to 3) at the last follow-up. Conclusion For TCCs with severe forefoot abduction deformity in the geenagers, E-LLCOT after TCCs resection can effectively correct deformity, relieve pain and achieve significant functional and radiographic improvements. Key words: Foot; Talus; Calcaneus; Talocalcaneal coalition; Osteotomy