Nonunion and Calcaneocuboid Subluxation Are Minimal After Evans Osteotomy Without Fixation.

Background: Fixation of the Evans osteotomy for flatfoot correction has been advocated without supporting data to facilitate union and avoid calcaneocuboid subluxation. We examined these issues in the largest reported series of Evans procedures to date.

Methods: A total of 118 cases from a consecutive series of 137 patients who underwent Evans osteotomy without fixation by a single surgeon were available for review. Average follow-up was 62.5 weeks. Bony union and radiographic measurements including calcaneocuboid subluxation were evaluated.

Results: Union occurred in 117/118 cases (99.2%). Calcaneocuboid subluxation increased minimally compared to preoperative values (1.5 ± 2.3 mm). The mean wedge size was 7.1 ± 1.4 mm. All radiographic measurements of the longitudinal arch improved.

Conclusion: The Evans osteotomy without fixation demonstrated near-universal union and minimal calcaneocuboid subluxation. The frequent use of additional osteotomies in our series might have allowed the use of smaller wedges and contributed to our favorable results.

Level of evidence: 4.