Anatomical and functional guidelines for the correction hindfoot malalignment

BACKGROUND: The techniques for the surgical correction of a hindfoot valgus deformity usually include both bony and soft-tissue techniques, depending on the deformity severity. Medializing calcaneal osteotomy (MCO) is one of the main surgical techniques used to correct such deformities. However, the degree of deformity in different patients can vary significantly; thus, using the above principle, the degree of calcaneal postoperative correction can vary considerably. Based on data from various authors, patients with an insufficient correction of the heel bone axis have a residual valgus in the hindfoot. However, the lack of complete correction may result in the persistence of complaints and corrected limb recurrence.

OBJECTIVE: To improve the surgical treatment of hindfoot malalignment.

MATERIAL AND METHODS: The study analyzed treatment results of patients with ankle sprain in the Center Traumatology and Orthopedics (Moscow) between 2012 and 2020. All implantations were performed by two surgeons. The total number of patients is 60. Fifty-five patients with follow-up periods of over 12 months after the procedure were available for a retrospective analysis and assessment of results. The study enrolled 20 men and 35 women, with a mean age of 61.6 (18,5–40,7) years years. The mean follow-up period is 62 (18–80) months.

RESULT: The mean change in the Foot and Ankle Outcome Score (FAOS) pain subscale was 27.9 (range, −8.3 to 63.9) for the moderate varus group (n = 16), 41.2 (range, 5.6–66.7) for the mild varus group (n = 17), and 22.3 (range, −58.3 to 63.9) for the valgus group (n = 18). In addition, patients with mild varus demonstrated better clinical outcomes than those with valgus; however, this difference was not statistically significant (p=0.11). No differences were found between groups in the change in scores for daily activities (p=0.26), sports activities (p=0.06), or quality of life (p=0.17) subscales of the FAOS.

CONCLUSION: Patients with mild varus hindfoot alignment showed significantly greater improvement than those with valgus with respect to the FAOS pain subscale and significantly greater improvement than those with moderate varus in the FAOS symptoms subscale.