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Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model.

Publication ,  Journal Article
Zanolli, DH; Glisson, RR; Nunley, JA; Easley, ME
Published in: J Bone Joint Surg Am
March 19, 2014

BACKGROUND: Options for surgical correction of acquired flexible flatfoot deformity involve bone and soft-tissue reconstruction. We used an advanced cadaver model to evaluate the ability of key surgical procedures to correct the deformity and to resist subsequent loss of correction. METHODS: Stage-IIB flatfoot deformity was created in ten cadaver feet through ligament sectioning and repetitive loading. Six corrective procedures were evaluated: (1) lateral column lengthening, (2) medial displacement calcaneal osteotomy with flexor digitorum longus transfer, (3) Treatment 2 plus lateral column lengthening, (4) Treatment 3 plus "pants-over-vest" spring ligament repair, (5) Treatment 3 plus spring ligament repair with use of the distal posterior tibialis stump, and (6) Treatment 3 plus spring ligament repair with suture and anchor. Correction of metatarsal dorsiflexion and of navicular eversion were quantified initially and periodically during postoperative cyclic loading. RESULTS: Metatarsal dorsiflexion induced by arch flattening was initially corrected by 5.5° to 10.6°, depending on the procedure. Navicular eversion was initially reduced by 2.1° to 7.7°. The correction afforded by Treatments 1, 3, 4, 5, and 6 exceeded that of Treatment 2 initially and throughout postoperative loading. Inclusion of spring ligament repair did not significantly enhance correction. CONCLUSIONS: Under the tested conditions, medial displacement calcaneal osteotomy with flexor digitorum longus tendon transfer was inferior to the other evaluated treatments for stage-IIB deformity. Procedures incorporating lateral column lengthening provided the most sagittal and coronal midfoot deformity correction. Addition of spring ligament repair to a combination of these three procedures did not substantially improve correction. CLINICAL RELEVANCE: An understanding of treatment effectiveness is essential for optimizing operative management of symptomatic flatfoot deformity. This study provides empirical evidence of the advantage of lateral column lengthening and novel information on resistance to postoperative loss of correction.

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Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

March 19, 2014

Volume

96

Issue

6

Start / End Page

e45

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tendon Transfer
  • Osteotomy
  • Orthopedics
  • Orthopedic Procedures
  • Middle Aged
  • Male
  • Ligaments, Articular
  • Humans
  • Foot
 

Citation

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ICMJE
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Zanolli, D. H., Glisson, R. R., Nunley, J. A., & Easley, M. E. (2014). Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model. J Bone Joint Surg Am, 96(6), e45. https://doi.org/10.2106/JBJS.L.00258
Zanolli, Diego H., Richard R. Glisson, James A. Nunley, and Mark E. Easley. “Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model.J Bone Joint Surg Am 96, no. 6 (March 19, 2014): e45. https://doi.org/10.2106/JBJS.L.00258.
Zanolli DH, Glisson RR, Nunley JA, Easley ME. Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model. J Bone Joint Surg Am. 2014 Mar 19;96(6):e45.
Zanolli, Diego H., et al. “Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model.J Bone Joint Surg Am, vol. 96, no. 6, Mar. 2014, p. e45. Pubmed, doi:10.2106/JBJS.L.00258.
Zanolli DH, Glisson RR, Nunley JA, Easley ME. Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model. J Bone Joint Surg Am. 2014 Mar 19;96(6):e45.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

March 19, 2014

Volume

96

Issue

6

Start / End Page

e45

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tendon Transfer
  • Osteotomy
  • Orthopedics
  • Orthopedic Procedures
  • Middle Aged
  • Male
  • Ligaments, Articular
  • Humans
  • Foot