Severe Flexible Pes Planovalgus Deformity Correction Using Trabecular Metallic Wedges

• Published in: Foot & ankle international Vol. 40; no. 4; pp. 402 - 407
• Main Authors: Tsai, Justin, McDonald, Elizabeth, Sutton, Ryan, Raikin, Steven M.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2019
• Subjects: Calcaneus - diagnostic imaging; Calcaneus - pathology; Calcaneus - surgery; Female; Flatfoot - diagnostic imaging; Flatfoot - pathology; Flatfoot - surgery; Humans; Male; Middle Aged; Osteotomy; Pain Measurement; Porosity; Prostheses and Implants; Prosthesis Implantation; Radiography; Retrospective Studies; Surveys and Questionnaires; Tarsal Bones - diagnostic imaging; Tarsal Bones - pathology; Tarsal Bones - surgery; Titanium; lengthening; wedge; osteotomy; Cotton; Evans; metallic
• DOI: 10.1177/1071100718816054
• EISSN: 1944-7876
• ISSN: 1071-1007

Background:
Lateral column lengthening and plantarflexion dorsal opening wedge osteotomy of the medial cuneiform are 2 commonly used procedures to address the deformity seen in severe flexible pes planovalgus deformity. Traditionally, iliac crest allograft or autograft has been used to fill the osteotomy sites. Porous metallic wedges can be used as an alternative to avoid the concerns associated with both autograft and allograft.
Methods:
We performed a retrospective review of patients who had corrective osteotomies utilizing metallic wedges to address flexible pes planovalgus with at least 2 years of follow-up data. Preoperative radiographic measurements (anteroposterior [AP] and talo-first metatarsal angle, calcaneal pitch, talocalcaneal angle, and talonavicular uncoverage angle) and functional scores (visual analog scale [VAS] pain, Foot and Ankle Ability Measure [FAAM] Activities of Daily Living [ADL], FAAM Sports) were compared to postoperative radiographic measurements and functional scores.
Results:
There were statistically significant improvements in all radiographic parameters and functional scores. Two nonunions were seen, one of which healed with revision surgery while the other was asymptomatic. At the time of last radiographic follow-up, there were no recurrences of deformity or collapse.
Conclusion:
Porous metallic wedges offer an attractive alternative to autograft and/or allograft in the setting of corrective osteotomies for severe flexible pes planovalgus. Patients who underwent corrective osteotomies using these wedges demonstrated reliable, effective, and stable radiographic correction as well as significant improvements in function and pain.
Level of Evidence:
Level IV, case series.