Consensus for the Indication of Lateral Column Lengthening in the Treatment of Progressive Collapsing Foot Deformity

Abstract

Recommendation:

Progressive collapsing foot deformity (PCFD) is a complex 3D deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot supination. Although a medial displacement calcaneal osteotomy can correct heel valgus, it has far less ability to correct forefoot abduction. More severe forefoot abduction, most frequently measured preoperatively by assessing talonavicular coverage on an anteroposterior (AP) weightbearing conventional radiographic view of the foot, can be more effectively corrected with a lateral column lengthening procedure than by other osteotomies in the foot. Care must be taken intraoperatively to not overcorrect the deformity by restricting passive eversion of the subtalar joint or causing adduction at the talonavicular joint on simulated AP weightbearing fluoroscopic imaging. Overcorrection can lead to lateral column overload with persistent lateral midfoot pain. The typical amount of lengthening of the lateral column is between 5 and 10 mm.

Level of Evidence:

Level V, consensus, expert opinion.

CONSENSUS STATEMENT ONE:

Lateral column lengthening (LCL) procedure is recommended when the amount of talonavicular joint uncoverage is above 40%. The amount of lengthening needed in the lateral column should be judged intraoperatively by the amount of correction of the uncoverage and by adequate residual passive eversion range of motion of the subtalar joint.

Delegate vote: agree, 78% (7/9); disagree, 11% (1/9); abstain, 11% (1/9).

(Strong consensus)

CONSENSUS STATEMENT TWO:

When titrating the amount of correction of abduction deformity intraoperatively, the presence of adduction at the talonavicular joint on simulated weightbearing fluoroscopic imaging is an important sign of hypercorrection and higher risk for lateral column overload.

Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%.

(Unanimous, strongest consensus)

CONSENSUS STATEMENT THREE:

The typical range for performing a lateral column lengthening is between 5 and 10 mm to achieve an adequate amount of talonavicular coverage.

Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%.

(Unanimous, strongest consensus)

Keywords

flatfoot adult-acquired flatfoot deformity AAFD reconstruction osteotomy Evan’s osteotomy lateral column lengthening LCL progressive collapsing foot deformity PCFD

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References

Chan

Greenfield

Soukup

Deland

Ellis

. Contribution of lateral column lengthening to correction of forefoot abduction in stage IIb adult acquired flatfoot deformity reconstruction. Foot Ankle Int. 2015;36(12):1400-1411.

Conti

Chan

Ellis

Deland

. Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity. Foot Ankle Int. 2015;36(3):239-247.

Conti

Deland

Ellis

. Stage IIB flatfoot reconstruction using literature-based equations for heel slide and lateral column lengthening. Tech Foot Ankle Surg. 2017;16(4):153-166.

Deland

. Adult-acquired flatfoot deformity. J Am Acad Orthop Surg. 2008;16(7):399-406.

Demetracopoulos

Nair

Malzberg

Deland

. Outcomes of a stepcut lengthening calcaneal osteotomy for adult-acquired flatfoot deformity. Foot Ankle Int. 2015;36(7):749-755.

Dolan

Henning

Anderson

Bohay

Kornmesser

Endres

. Randomized prospective study comparing tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for operative correction of adult acquired flatfoot deformity. Foot Ankle Int. 2007;28(1):8-12.

Ellis

Williams

Garg

Campbell

Pavlov

Deland

. Incidence of plantar lateral foot pain before and after the use of trial metal wedges in lateral column lengthening. Foot Ankle Int. 2011;32(7):665-673.

Ellis

Johnson

Elliott

O’Malley

Deland

. Plantar pressures in patients with and without lateral foot pain after lateral column lengthening. J Bone Joint Surg Am. 2010;92(1):81-91.

Ettinger

Mattinger

Stukenborg-Colsman

, et al. Outcomes of Evans versus Hintermann calcaneal lengthening osteotomy for flexible flatfoot. Foot Ankle Int. 2019;40(6):661-671.

10.

Grier

Walling

. The use of tricortical autograft versus allograft in lateral column lengthening for adult acquired flatfoot deformity: an analysis of union rates and complications. Foot Ankle Int. 2010;31(9):760-769.

11.

Gross

Huh

Gray

Demetracopoulos

Nunley

. Radiographic outcomes following lateral column lengthening with a porous titanium wedge. Foot Ankle Int. 2015;36(8):953-960.

12.

Grunander

Thordarson

. Results of calcaneocuboid distraction arthrodesis. Foot Ankle Surg. 2012;18(1):15-18.

13.

Haddad

Myerson

Younger

Anderson

Davis

Manoli

2nd . Symposium: Adult acquired flatfoot deformity. Foot Ankle Int. 2011;32(1):95-111.

14.

Hintermann

Valderrabano

Kundert

. Lateral column lengthening by calcaneal osteotomy combined with soft tissue reconstruction for treatment of severe posterior tibial tendon dysfunction. Methods and preliminary results [in German]. Orthopade. 1999;28(9):760-769.

15.

Hunt

Farmer

. The undercorrected flatfoot reconstruction. Foot Ankle Clin. 2017;22(3):613-624.

16.

Iossi

Johnson

McCormick

Klein

. Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity. Foot Ankle Int. 2013;34(6):781-791.

17.

Kitaoka

Kura

Luo

. Calcaneocuboid distraction arthrodesis for posterior tibial tendon dysfunction and flatfoot: a cadaveric study. Clin Orthop Relat Res. 2000;381:241-247.

18.

Mosier-LaClair

Pomeroy

Manoli

2nd . Operative treatment of the difficult stage 2 adult acquired flatfoot deformity. Foot Ankle Clin. 2001;6(1):95-119.

19.

Imhauser

Choi

Williams

Ellis

Deland

. Sensitivity of plantar pressure and talonavicular alignment to lateral column lengthening in flatfoot reconstruction. J Bone Joint Surg Am. 2013;95(12):1094-100.

20.

Saltzman

el-Khoury

. The hindfoot alignment view. Foot Ankle Int. 1995;16(9):572-576.

21.

Sangeorzan

Mosca

Hansen

Jr . Effect of calcaneal lengthening on relationships among the hindfoot, midfoot, and forefoot. Foot Ankle. 1993;14(3):136-141.

22.

Saunders

Ellis

Demetracopoulos

Marinescu

Burkett

Deland

. Comparative outcomes between step-cut lengthening calcaneal osteotomy vs traditional evans osteotomy for stage IIB adult-acquired flatfoot deformity. Foot Ankle Int. 2018;39(1):18-27.

23.

Vander Griend

. Lateral column lengthening using a “Z” osteotomy of the calcaneus. Tech Foot Ankle Surg. 2008;7(4):257-263.

24.

Vosseller

Ellis

O’Malley

, et al. Autograft and allograft unite similarly in lateral column lengthening for adult acquired flatfoot deformity. HSS J. 2013;9(1):6-11.

25.

Vulcano

Deland

Ellis

. Approach and treatment of the adult acquired flatfoot deformity. Curr Rev Musculoskelet Med. 2013;6(4):294-303.

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