An adult acquired flatfoot deformity (AAFD) is a complex 3D deformity. Surgical correction consists of a medial calcaneal osteotomy (MCO) but shows limitations due to the current 2D assessment. Therefore, the aim is to determine the influence of an MCO on the longitudinal foot arch assessed by 2D and 3D weightbearing CT (WBCT). Seventeen patients with a mean age of 44,5 years (range 18–66 yrs) were retrospectively included. MCO was indicated in a stage II AAFD (N=15) and a post-traumatic valgus deformity (N=2). Pre- and post-operative imaging was obtained from a WBCT. The height of the longitudinal foot arch was measured as the distance from the navicular tuberositas to the floor (Navicular Height, NH) on 2D CT images (NH_2D) and computed on 3D CT data (NH_3D). Additionally, 3D assessment could compute the degree of exorotation (α) of the navicular bone towards the vertical axis. The mean pre-operative NH_2D and NH_3D were respectively 29.57mm ± 7.59 and 28.34mm ± 6.51. These showed to be statistically different from the mean post-operative NH_2D and NH_3D, respectively 31.62mm ± 6.69 and 31.67mm ± 6.47 (p < 0,001). A statistical difference was also found when comparing the mean degree of exorotation in pre- and post-operative, respectively: α_pre=14.08° ± 4,92 and the α_post=19,88° ± 3.50 (p < 0,001). This study demonstrates a significant correction of the longitudinal foot arch after a MCO. The novelty is attributed to the accurate degree of rotation assessment using WBCT. This information could be assistive to optimise a pre-operative planning.

Aims: Surgical management of hallux rigidus remains a controversial subject. The purpose of the study is to compare the results of arthroscopic and open cheilectomie in a prospective and randomised manner. Method: Between October 2000 and December 2001, 26 patients (29 feet) were operated because of grade 1 and 2 hallux rigidus. Mean age was 54.8 (36–71). Patients were operated using arthroscopic cheilectomy and release or open cheilectomy. Standard technique was used in both groups. Type of technique was choosen in a randomised manner. Preoperative evaluation was performed with standard x-rays and x-rays in maximum dorsißexion and plantarßexion. Mean preoperative AOFAS score was 60.83/100. Both groups had the same preoperative prothorn;le. Results: Mean postoperative score was 90.5/100 in the open group and 83.1/100 in the arthroscopic group (p< 0.05). Hospital stay was shorter. The arthroscopy group had better results in mobility because they had less pain and were able to perform more intensiþed rehabilitation (p> 0.05). All patients had improved function and mobility (p< 0.05). Conclusion: Management of moderate hallux rigidus with cheilectomy is a reliable method for relieving pain and increase mobility on short terms. Arthroscopic treatment has a considerable learning curve which inßuences the outcome. We think that more experience in the þeld of arthroscopy of the þrst mtp joint leads to less pain in the postoperative phase allowing for more intensiþed rehabilitation, shorter hospital stay, better cosmetic result, less problems with shoe wear and quicker restart of professional activities.

There are many reports of treatment for intraarticular fractures of the calcaneus using different methods. Results are very difficult to compare. For this reason a prospective study was designed to compare the outcome of the same type of fracture treated with Stein-mann pinning or plate osteosynthesis.

Between January 1995 and March 1999 31 patients with two-part intraarticular fractures of the calcaneus, type IIB according to the Sanders classification, were treated operatively with either transcalcaneal pinning (12 fractures) or with open reduction and internal plate and screw fixation using a lateral approach (19 fractures). After a mean follow-up of 26 months all patients were assessed. A comparison was made between the two modes of treatment. The global score averaged 78.3 ± 12.1; 79.3 ± 11.14 for the patients treated with plate and screw fixation, and 76.6 ± 13.2 for the patients who underwent pinning. Lateral X-rays showed no difference in anatomical reduction between both methods. A positive correlation was demonstrated between the AOFAS Ankle-Hindfoot score and Böhler’s angle. The restoration of the congruity of the posterior subtalar joint was assessed postoperatively by means of a CT scan. The angle between the undersurface of the talus and the lateral fragment of the two-part fracture was evaluated. No statistically significant difference was found between both groups.

The authors conclude that there is no difference in functional outcome between both modes of treatment. Plate osteosynthesis has the advantage that the shape of the hindfoot and midfoot is restored, but the higher complication rate is a drawback.