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Introduction: Joint preserving surgery for flatfoot reconstruction utilizes correction of bony malalignment and medial soft tissue reconstruction. A medial displacement calcaneal osteotomy (MDCO) can be an essential adjunct to deformity correction and good patient outcomes. Our cadaveric study compares three different surgical techniques utilizing two cannulated screws to best maintain medial translation of the calcaneal osteotomies. Materials and methods: Fifteen above knee fresh-frozen, matched pair cadaveric specimens (30 limbs) were randomized equally to three groups. MDCO were performed on all specimens, followed by manual 10 mm translation. The groups consisted of a “simultaneous drilling,” “staggered drilling,” and a control group, which involved simultaneous drilling of only the near cortex. Following screw fixation, the calcaneal tuberosity was manually translated in a lateral direction. The loss of correction was measured in millimeters. Results: The “simultaneous” drilling group experienced the greatest mean loss of correction at 2.6 mm (range 1.37–3.48 mm). The “staggered” group showed an average loss of 1.16 mm (range 0.36–2.67 mm). The control group demonstrated the greatest maintenance of correction with a mean loss of 0.036 mm (range 0.01–0.06 mm). Conclusions: MDCO realigns the hindfoot adding support to the medial soft tissue reconstruction during flatfoot correction. Loss of initial correction may result in residual deformity and poor long-term outcomes. Our study demonstrates that simultaneous drilling of only the tuberosity near cortex prior to screw fixation was the best at maintaining osteotomy correction. Level of evidence: : Level V, Cadaveric study

The article discusses research which was conducted to investigate the contribution of medializing calcaneal osteotomy (MCO) on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity. Researchers evaluated 30 patients with flatfoot deformity who underwent reconstruction. They found that the correction of hindfoot valgus alignment obtained in flatfoot reconstruction is primarily determined by the MCO procedure and can be modeled linearly.

Adult acquired flatfoot deformity is a debilitating condition typically affecting middle-aged patients. The multiple components include hindfoot valgus, first ray elevation, medial soft tissue compromise, and forefoot abduction. As the foot becomes unbalanced, the deformity progresses with repetitive loading and time. Untreated patients often need significant reconstructions or extensive arthrodesis after arthritis and joint contractures present. Medializing calcaneal osteotomy is the workhorse operation for correction of hindfoot valgus, reliably correcting deformity with a relatively low complication risk. This article reviews indications, techniques, complications, and outcomes for the medializing calcaneal osteotomy., (Copyright © 2017 Elsevier Inc. All rights reserved.)