COMPLICATIONS OF CALCANEAL OSTEOTOMY

Abstract

Background: Calcaneal osteotomy is performed commonly as an adjunct to many corrective procedures of the abnormal hindfoot. Preservation of the hindfoot joints restores the normal biomechanics and can potentially delay arthritic changes in adjacent joints. Calcaneal osteotomy improves the weight bearing alignment of the foot by reducing varus or valgus deformity without impairing subtalar or mid-tarsal joint function. We are unaware of any studies documenting the complication rates associated with this procedure.

Methods: 36 calcaneal osteotomies (medial and lateral displacement, and Dwyer) were performed on 35 patients between April 2005 and October 2007 by the senior surgeon. Data was collected retrospectively by review of casenotes and assessment of radiographs. Average age was 54 years (range 18 to 81) and mean time of follow-up was 22 months (6 to 36). Indications were varus OA deformity (40%), Posterior tibialis tendon deficiency (30%), Charcot-Marie-Tooth (12%) and pes cavus (17%).

Results: All case notes and radiographs were available for analysis. Eight patients (22%) developed a complication. One patients (5%) had failed to fuse at 6 weeks following surgery. This patients developed a non-union and required re-fusion with bone grafting. Two patients (10%) had sural nerve damage, which persisted and required specialist pain team involvement. Two patients developed symptoms relating to prominent screws. A further two patients had wound breakdown and one had a superficial infection. In total, there were five further procedures (14%) – two directly related to problems with the calcaneal osteotomy. All osteotomies united within a translation distance of 10% in the sagittal plane.

Discussion: Calcaneal osteotomy is a useful adjunct procedure for correcting anatomical malalignment of the hindfoot in several conditions, with an acceptable complication rate and a low re-operation rate.