Evans Osteotomy Without Bone Graft in Stage IIB Adult Flatfoot Deformity
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Published:
Feb 17, 2023
Keywords:
Flatfoot deformity, Evans osteotomy, lateral column lengthening
Main Article Content
Abstract
Objective: To evaluate the radiological and functional outcomes one year after surgery in a consecutive series of patients diagnosed with stage IIB adult-acquired flatfoot deformity who underwent Evans osteotomy without the use of bone graft.
Materials and Methods: Two groups of patients were retrospectively evaluated: group 1 (spacer plate, n=12) and group 2 (PEEK cage, n=14). The mean age was 47 years (SD 18) in group 1 and 54 years (SD 12) in group 2.
Results: 26 patients (28 feet) were evaluated; 14 (84%) of the patients were women. Radiographic measurements—calcaneal pitch angle, (lateral) talocalcaneal angle, (AP) talocalcaneal angle, talonavicular coverage angle, medial column height, lateral column length—yielded statistically significant differencesbetween preoperative measurements and those taken one year after surgery. The mean score on the AOFAS scale one year after surgery was 96 (SD 4.70) in group 1 and 95 (SD 4.98) in group 2. Regarding the visual analog scale, it was 1.2 (SD 0.42) in group 1 and 1.16 (SD 0.46) in group 2.
Conclusions: According to the results obtained, we conclude that Evans osteotomy without the use of bone graft manages to preserve the corrections obtained in the medium term, using either spacer plates or PEEK cages.
Materials and Methods: Two groups of patients were retrospectively evaluated: group 1 (spacer plate, n=12) and group 2 (PEEK cage, n=14). The mean age was 47 years (SD 18) in group 1 and 54 years (SD 12) in group 2.
Results: 26 patients (28 feet) were evaluated; 14 (84%) of the patients were women. Radiographic measurements—calcaneal pitch angle, (lateral) talocalcaneal angle, (AP) talocalcaneal angle, talonavicular coverage angle, medial column height, lateral column length—yielded statistically significant differencesbetween preoperative measurements and those taken one year after surgery. The mean score on the AOFAS scale one year after surgery was 96 (SD 4.70) in group 1 and 95 (SD 4.98) in group 2. Regarding the visual analog scale, it was 1.2 (SD 0.42) in group 1 and 1.16 (SD 0.46) in group 2.
Conclusions: According to the results obtained, we conclude that Evans osteotomy without the use of bone graft manages to preserve the corrections obtained in the medium term, using either spacer plates or PEEK cages.
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How to Cite
Villena, D. S., Sotelano, P., Santini Araujo, M. G., Conti, L., Parise, A. C., & Carrasco, M. (2023). Evans Osteotomy Without Bone Graft in Stage IIB Adult Flatfoot Deformity. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(1), 13-21. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1631
Section
Clinical Research
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15. Kang S, Charlton TP, Thordarson DB. Lateral column lengthening in adult flatfoot deformity. Foot Ankle Int
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20. Tomford WW, Starkweather RJ, Goldman MH. A study of the clinical incidence of infection in the use of banked allograft bone. J Bone Joint Surg Am 1981;63(2):244-8. PMID: 7007391
21. Cooper PS, Nowak MD, Shaer J. Calcaneocuboid joint pressures with lateral column lengthening (Evans)
procedure. Foot Ankle Int 1997;18(4):199-205. https://doi.org/10.1177/107110079701800403
22. Xia J, Zhang P, Yang YF, Zhou JQ, Li QM, Yu GR. Biomechanical analysis of the calcaneocuboid joint pressure
after sequential lengthening of the lateral column. Foot Ankle Int 2013;34(2):261-6. https://doi.org/10.1177/1071100712464211
23. Momberger N, Morgan JM, Bachus KN, West JR. Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model. Foot Ankle Int 2000;21(9):730-5. https://doi.org/10.1177/107110070002100903
2. Sands AK, Tansey JP. Lateral column lengthening. Foot Ankle Clin 2007;12(2):301-8. https://doi.org/10.1016/j.fcl.2007.03.007
3. Bare AA, Haddad SL. Tenosynovitis of the posterior tibial tendon. Foot Ankle Clin 2001;6:37-66.
https://doi.org/10.1016/s1083-7515(03)00078-0
4. Beals TC, Pomeroy GC, Manoli A 2nd. Posterior tendon insufficiency: diagnosis and treatment. J Am Acad Orthop Surg 1999;7(2):112-8. https://doi.org/10.5435/00124635-199903000-00004
5. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 1989;(239):196-206.
PMID: 2912622
6. Bluman EM, Title CI, Myerson MS. Posterior tibial tendon rupture: A refined classification system. Foot Ankle Clin 2007;12(2):233-49. https://doi.org/10.1016/j.fcl.2007.03.003
7. Coughlin M, Kaz A. Correlation of Harris mats, physical exam, pictures, and radiographic measurements in adult flatfoot deformity. Foot Ankle Int 2009;30(7):604-12. https://doi.org/10.3113/FAI.2009.0604
8. Niño Gomez D, Eslava S, Anain F, Yearson D, Arrondo G, Joannas G. Use of poly (ether ether ketone) cages in foot and ankle surgery. Foot Ankle Clin 2012;17(3):449-57. https://doi.org/10.1016/j.fcl.2012.07.001
9. Hiller L, Pinney SJ. Surgical treatment of acquired flatfoot deformity: what is the state of practice among academic foot and ankle surgeons in 2002? Foot Ankle Int 2003;24(9):701-5. https://doi.org/10.1177/107110070302400909
10. Hintermann B, Valderrabano V, Kundert HP. Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int 1999;20(10):622-9. https://doi.org/10.1177/107110079902001002
11. Liao JC, Niu CC, Chen WJ, Chen LH. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 2008;32(5):643-8. https://doi.org/10.1007/s00264-007-0378-x
12. Ahn JY, Lee HS, Kim CH, Yang JP, Park SS. Calcaneocuboid joint subluxation after the calcaneal lengthening
procedure in children. Foot Ankle Int 2014;35(7):677-82. https://doi.org/10.1177/1071100714528494
13. Chan JY, Greenfield ST, Soukup DS, Do HT, Deland JT, Ellis SJ. Contribution of lateral column lengthening
to correction of forefoot abduction in stage IIb adult acquired flatfoot deformity reconstruction. Foot Ankle Int
2015;36(12):1400-11. https://doi.org/10.1177/1071100715596607
14. Benthien RA, Parks BG, Guyton GP, Schon LC. Lateral column calcaneal lengthening, flexor digitorum longus
transfer, and opening wedge medial cuneiform osteotomy for flexible flatfoot: a biomechanical study. Foot Ankle Int 2007;28(1):70-7. https://doi.org/10.3113/FAI.2007.0013
15. Kang S, Charlton TP, Thordarson DB. Lateral column lengthening in adult flatfoot deformity. Foot Ankle Int
2013;34(3):392-7. https://doi.org/10.1177/1071100712465738
16. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989;3(3):192-5.
https://doi.org/10.1097/00005131-198909000-00002
17. Cockin J. Autologous bone grafting complications at the donor site. J Bone Joint Surg Br 1971;53(1):153.
https://doi.org/10.1302/0301-620X.53B1.147
18. Shin AY, Moran ME, Wenger DR. Superior gluteal artery injury secondary to posterior iliac crest bone graft
harvesting. Spine (Phila Pa 1976) 1996;21(11):1371-4. https://doi.org/10.1097/00007632-199606010-00019
19. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft
harvesting. Clin Orthop Relat Res 1996;(329):300-9. https://doi.org/10.1097/00003086-199608000-00037
20. Tomford WW, Starkweather RJ, Goldman MH. A study of the clinical incidence of infection in the use of banked allograft bone. J Bone Joint Surg Am 1981;63(2):244-8. PMID: 7007391
21. Cooper PS, Nowak MD, Shaer J. Calcaneocuboid joint pressures with lateral column lengthening (Evans)
procedure. Foot Ankle Int 1997;18(4):199-205. https://doi.org/10.1177/107110079701800403
22. Xia J, Zhang P, Yang YF, Zhou JQ, Li QM, Yu GR. Biomechanical analysis of the calcaneocuboid joint pressure
after sequential lengthening of the lateral column. Foot Ankle Int 2013;34(2):261-6. https://doi.org/10.1177/1071100712464211
23. Momberger N, Morgan JM, Bachus KN, West JR. Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model. Foot Ankle Int 2000;21(9):730-5. https://doi.org/10.1177/107110070002100903