ObjectiveTo investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity.MethodsBetween January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation.ResultsAll incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores (t=?23.380, P=0.000; t=35.218, P=0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones (P<0.05), and the CP was significantly higher than preoperative one (P<0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot).ConclusionFor TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain.
Objective To explore effectiveness of the Lapidus arthrodesis combined with the middle metatarsal base rotation osteotomy in the treatment of hallux valgus (HV) with metatarsus adductus (MA). Methods Between February 2023 and September 2024, 18 patients (18 feet) of HV with MA were underwent Lapidus arthrodesis combined with the middle metatarsal base rotation osteotomy. There were 5 males and 13 females with an age of 50-68 years (mean, 55.3 years). The foot deformity was characterized by severe HV, redness and swelling at the utricle, and the corpus callosum on the plantar side of the forefoot. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 44.2±3.8 and visual analogue scale (VAS) score was 7.1±0.9 after walking 1 km. The AOFAS score and VAS score were adopted to evaluate the postoperative function of the foot. The hallux valgus angle (HVA), metatarsus adductus angle (MAA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured after operation. ResultsAll incisions healed by first intention. All patients were followed up 12-26 months (mean, 18 months). At last follow-up, the AOFAS score and VAS score after walking 1 km were 84.2±3.9 and 2.0±0.8, respectively, showing significant differences when compared with preoperative scores (P<0.05). Imaging review showed that the osteotomy sites all healed, with a healing time of (10.25±2.15) weeks. At last follow-up, the HVA, MAA, IMA, and DMAA were significantly lower than preoperative ones (P<0.05). During follow-up, all patients exhibited diffuse swelling of the feet, 10 patients experienced stiffness in the great toe, 1 foot showed numbness caused by medial plantar cutaneous nerve injury, and 1 foot of skin irritation caused by internal fixation. ConclusionFor HV with MA, the Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy can effectively correct deformity and relieve pain.