Anterior calcaneal osteotomy

Anterior calcaneal osteotomy is used for the treatment of flexible flat feet. Evans believes that the lateral foot deformity of the flat foot deformity is shortened, and the anterior calcaneus osteotomy is proposed, and the lateral bone column is extended with the iliac bone graft to treat the deformable flat foot. Anderson and Fowler used a combination of anterior calcaneal osteotomy and posterior tibial tendon advancement, and replaced the iliac bone graft with the iliac bone graft. The following describes the Anderson and Fowler surgical methods Treatment of diseases: flat feet Indication The anterior calcaneal osteotomy is suitable for the deformable flat foot, the main joint of the foot is not severely slack or the tibia is obviously deformed, the symptoms are heavier, and the non-surgical treatment is invalid. Preoperative preparation Including the anterior and lateral X-ray of the foot, skin preparation, osteotome, hand drill, Sterling nail or Kirschner wire orthopedic instruments. Surgical procedure 1. Make a straight lateral skin incision from the outside of the iliac crest, about 1.5cm from the outer iliac crest, and extend 5 to 6cm to the distal side, crossing the Achilles tendon at a right angle. Exposes and protects the sural nerve and its branches. The tendon tendon is retracted to the temporal side. The achilles tendon is identified by passive abduction and adduction activities of the forefoot and midfoot or with a straight needle. The periosteum was cut open to the anterior aspect of the calcaneus and turned to the dorsal side. In the anterior calcaneus 4 to 5 mm behind the ankle joint, an open osteotomy was performed with a 1.2 cm wide bone knife. The bone knife should not be cut through the medial cortical bone of the calcaneus. The internal fixation of the calcaneus and the advancement of the forefoot force the osteotomy. If you have difficulty, you can drill 2 to 3 small holes in the medial cortex of the calcaneus, and repeat the above method. 2. Make a slightly curved skin incision in the medial aspect of the foot, starting from the anterior and posterior aspect of the medial malleolus and advancing to the base of the first metatarsal. The posterior tendon is freed and its attachment point on the scaphoid and the first clavicle is separated, but its distal end point is retained. The posterior tibial tendon is cut at the plane of the wedge joint. The joint capsule of the scaphoid is cut transversely, so that the reduction of the joint can be seen. 3. Take a wedge-shaped bone graft with bilateral cortical bone from the humerus, the width of which is 5-8 mm, the wedge-shaped base is outward, and the dorsal side is slightly wider than the temporal side, and it is implanted into the open calcaneal osteotomy. To lengthen the lateral column and correct the forefoot abduction, heel valgus and subluxation of the scaphoid joint. 4. Move the posterior tibial tendon to the side of the scaphoid, advance about 2 cm to the distal side, and tighten the lateral suture with the distal end. The proximal part of the joint capsule of the scaphoid is pushed distally to make an overlapping suture. 5. Check whether the deformity of the anterior ankle joint is corrected. If it is not corrected, the anterior tibial tendon can be retracted to the dorsal side. The closed bone is made at the first cuneiform bone, and the wedge base is moved to the temporal side to correct the forefoot. Spinal deformity at the ankle joint. The wedge osteotomy is fixed with a Kirschner wire. 6. Suture the incision in layers. complication The main complication of anterior calcaneal osteotomy is uncorrected deformity, unresolved symptoms and non-healing at the osteotomy.