DWYER OSTEOTOMY OF THE CALCANEUM: REVIEW OF 22 OSTEOTOMIES, INDICATIONS AND RESULTS

Abstract

Purpose: Dwyer osteotomy remains controversial as shown by the numerous series reported. Conclusions have varied and there is no real consensus. The cause of these divergent opinions is related to the variability of indications (association or not with active neurological disease) and surgical schools. Interpretation of outcome and comparisons are hindered.

Material and methods: We reviewed 22 cases of Dwyer osteotomy of the calcaneum performed between 1972 and 2002. The lateral approach was used for closed osteotomy. Mean follow-up was ten years (1–30). Patients were aged 8 to 55 years. The objective and subjective rating system of Laaveg and Panseti (1980) was used. Indications were: neurological pes cavus (n=13) including five unilateral and four bilateral cases, pes equinovarus sequela of clubfoot (n=n=2), idiopathic varus of the hindfood with ankle instability (n=5), posttraumatic varus sequela of a compartment syndrome (n=2).

Discussion: Dwyer osteotomy is rarely performed alone and is frequently associated with other interventions (tendon lengthening and transfer, forefoot procedure, toe procedure) making it difficult to interpret results. Our study was not designed to draw definitive conclusion but rather to compare our indications and results with earlier reports.

Conclusion: Dwyer osteotomy performed with a rigorous technique appears to be an effective means for correcting constitutional varus. The site of the osteotomy and bone resection are particularly important. There are few complications. Bone healing is generally achieved. The procedure is an excellent solution for patients with associated ankle instability because it provides an easy and effective way to correct moderate varus. It is also a good solution for revision of clubfoot when aponeurotic and tendon release is also indicated. Results are insufficient for neurological pes cavus when there is residual or active tendon imbalance. It can however be a temporary solution in the young patient who will undergo arthrodesis later.