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Evaluating midcalcaneal length after
Evans calcaneal osteotomy: a
comparison of the locking plate and
tricortical allograft wedge
Garrett M. Wobst, DPM, AACFAS, Nicole M. Protzman, BS, MS,
Raymond E. McCarroll, DPM, FACFAS, Stephen A. Brigido, DPM, FACFAS
IFFAS • AOFAS
Chicago, 2014
My disclosure is in the final AOFAS mobile app.
I have no potential conflicts with this presentation.
Evaluating midcalcaneal length after
Evans calcaneal osteotomy: a
comparison of the locking plate and
tricortical allograft wedge
Garrett M. Wobst
IFFAS • AOFAS
Chicago, 2014
• Evans calcaneal osteotomy remains a
cornerstone in the correction of the
flexible flatfoot (1-5)
• Through lengthening of the lateral
column, tri-planar correction is
consistently achieved (6,7)
INTRODUCTION
Image source: http://www.foot-orthosis.com/tag/flat-foot/
INTRODUCTION
• Many methods have been employed to
maintain the length of the lateral column
(8)
• Tricortical autograft and allograft wedges
• Trabecular metal wedges
• Locking and non-locking plates
• Simple screw fixation
Figure from Butterworth, 2013 (9)
INTRODUCTION
• Compared with a tricortical graft, the locking plate has been shown
to better preserve lateral column length (10)
• Recently, a procedure-specific wedge
locking plate was designed to maintain
the mid-calcaneal length following
Evans osteotomy
Image source: http://footandanklefixation.com/product/
To compare the maintenance of mid-calcaneal length after
Evans calcaneal osteotomy when either a low profile wedge
locking plate or a tricortical allograft wedge was employed
HYPOTHESIS
• The wedge locking plate would better maintain mid-calcaneal length
compared with the tricortical allograft wedge
PURPOSE
Inclusion Criteria
• Presented with a reducible, flexible, symptomatic flatfoot
• Exhausted conservative treatment
• Elected to undergo surgical correction of the deformity
• Evans calcaneal osteotomy was performed
• Either a wedge locking plate or a tricortical allograft wedge was employed to maintain
postoperative mid-calcaneal length
• Minimum radiographic follow-up of 6 months
Retrospective chart review (September 2009 – June 2013)
Exclusion Criteria
• Underwent an adjunctive hindfoot, bony procedure at the time of osteotomy
Materials & Methods
Materials & Methods
• Immediate postoperative period, and
again at 3 months and 6 months
• Distance measured from the most
superior aspect of the convex arc on
the posterior subtalar facet and the
most inferior aspect of the concave arc
on the calcaneus at the calcaneo-
cuboid joint (10)
• Change in mid-calcaneal length o Immediate postoperative
measurements as baseline Figure from Dayton et al. 2013 (11)
Mid-calcaneal Length Measurements
Demographic All Patients
N = 24
Tricortical Allograft
Wedge
n = 9
Wedge Locking
Plate
n = 15
Age (yr) 48.1 ± 17.2 45.7 ± 20.1 49.6 ± 15.8
Body Mass Index (kg/m2) 31.8 ± 6.6 29.6 ± 7.7 32.9 ± 5.8
Gender
Female 18 (75.0) 8 (88.9) 10 (66.7)
Male 6 (25.0) 1 (11.1) 5 (33.3)
Patient Demographics
Results
Data presented as mean ± standard error or count (%).
Results
1.3
2.8
0.5 0.6 0
1
2
3
4
5
3 Months 6 Months
Δ M
id-c
alc
an
ea
l L
en
gth
(m
m)
Time
Tricortical Allograft Wedge Wedge Locking Plate
*
Data presented as mean ± standard error
Change in Mid-calcaneal Length
Discussion
• Our data indicate that the wedge locking plate better maintains mid-
calcaneal length compared with the tricortical allograft wedge 6
months following surgical correction
• Resorption of the allograft wedge at the bone graft interface may
cause a decrease in mid-calcaneal length
REFERENCES
1. Sangeorzan BJ, Mosca V, Hansen ST Jr. Effect of calcaneal lengthening on relationships among the hindfoot, midfoot, and
forefoot. Foot Ankle 14:136-141, 1993.
2. Guha AR, Perera AM. Calcaneal osteotomy in the treatment of adult acquired flatfoot deformity. Foot Ankle Clin 17:247-258,
2012.
3. Butterworth M. Maximizing the effectiveness of the Evans calcaneal osteotomy. Podiatry Today 26:20-26, 2011.
4. DeYoe BE, Wood J. The Evans calcaneal osteotomy. Clin Podiatr Med Surg 22:265-276, vi, 2005.
5. Roye DP Jr, Raimondo RA. Surgical treatment of the child’s and adolescent’s flexible flatfoot. Clin Podiatr Med Surg 17:515-
530, vii-viii, 2000.
6. Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br 57:270-278, 1975.
7. Arangio GA, Chopra V, Voloshin A, Salathe EP. A biomechanical analysis of the effect of lateral column lengthening
calcaneal osteotomy on the flat foot. Clin Biomech (Bristol, Avon) 22:472-477, 2007.
8. Abbasian A, Zaidi R, Guha A, Goldberg A, Cullen N, Singh D. Comparison of three different fixation methods of calcaneal
osteotomies. Foot Ankle Int 34:420-425, 2013.
9. Butterworth M. Maximizing the effectiveness of the Evans calcaneal osteotomy. Podiatry Today 26:20-26, 2011.
10. Dayton P, Prins DB, Smith DE, Feilmeier MJ. Effectiveness of a locking plate in preserving midcalcaneal length and
positional outcome after Evans calcaneal osteotomy: a retrospective pilot study. J Foot Ankle Surg 52:710-713, 2013.
11. Dayton P, Wienke JC Jr, Prins DB, Haulard JP, Feilmeier MJ, Wiarda C. Measurement of mid-calcaneal length on plain
radiographs: reliability of a new method. Foot Ankle Spec 4:280-283, 2011.