[Percutaneous calcaneal sliding osteotomy]

Abstract

Objectives: Correction of calcaneal malalignment as part of a hindfoot correction procedure.

Indications: Varus and valgus malalignment of the calcaneus, increased calcaneal pitch.

Contraindications: Osteoarthritis of the subtalar joint. Fixed and symptomatic deformities of the subtalar joint.

Surgical technique: After having identified and marked the desired planes of the osteotomy under image intensifier, a percutaneous v‑shaped calcaneal osteotomy is performed. The osteotomy allows 3‑dimensional correction of the calcaneus by defining the planes of the osteotomy. The procedure allows correction of varus and valgus deformities, as well as a change of the calcaneal pitch. The osteotomy is fixed by percutaneous screws.

Postoperative management: Postoperative care includes a 6-week period of partial weight bearing with 10 kg. The ankle joint should be mobilized. After x‑ray control of sufficient bone healing, weight bearing can be increased stepwise over another 4‑week period up to full body weight. A full length orthotic is recommended for at least 12 months with heel cup and good medial support.

Results: The procedure allows correction of calcaneal deformities with preservation of soft tissue, normally as part of a hindfoot correction, e. g., in posterior tibial tendon insufficiency, varus deformities or total ankle replacement. In the literature and in our patients, the rate of injuries of the neurovascular bundle was not increased compared to open surgery. The average calcaneal shift was 1 cm, when necessary an additional correction was realized by rotation of the tuber calcanei.

Keywords: Ankle joint; Bone malalignment; Calcaneus; Heel bone; Minimally invasive surgical procedures.