CALCANEAL OSTEOTOMY

KOUTSOGIANNIS

(MEDIAL TRANSLATION)

DWYER

(LATERAL CLOSING WEDGE)

Pes plano valgus

  • Calcaneum
  • Subtalar joint
  • Talus
  • T-N and N-C
  • Midtarsal joints
  • valgus
  • tilted medially
  • medialy and down
  • subluxation
  • Abduction
  • Valgus hindfoot

    Achilles tendon = evertor

Line of weight-bearing transmitted through the talus = medial to the calcaneus

three figures of line of weight-bearing calcaneus

CALCANEAL OSTEOTOMY FOR FLAT FOOT

  • 1893: posterior fragment forwards, medially and downwards (Gleich)
  • 1967: lateral opening wedge (Silver)
Flat foot Calcaneal Osteotomy illustration Flat foot Calcaneal Osteotomy illustration

CALCANEAL OSTEOTOMY FOR FLAT FOOT

  • 1971: medial translation of the posterior fragment (Koutsogiannis) – JBJS, febr 1971
Flat foot Calcaneal Osteotomy illustration

Surgical technique Koutsogiannis osteotomy

  • Lateral incision (parallel and behind peroneal tendon) sural nerve!
Calcaneal Osteotomy lateral incision Calcaneal Osteotomy inside the foot showing nerve

Surgical technique Koutsogiannis osteotomy

  • Incision periostum parallel to the incision
  • Illustration of Calcaneal Osteotomy lateral incision Calcaneal Osteotomy inside the foot

Surgical technique Koutsogiannis osteotomy

  • MEDIAL TRANSLATION POSTERIOR PART CALCANEUM ( 1/3 to ½ of the width of the calcaneus; 1 cm)
Illustration of Calcaneal Osteotomy screw cross section

Surgical technique Koutsogiannis osteotomy

Illustration of Calcaneal Osteotomy screw cross section x-ray of Calcaneal Osteotomy screw cross section

Surgical technique Koutsogiannis osteotomy

Open up heal operation

Postoperative care Koutsogiannis osteotomy

    Cast bellow-knee

  • non weight-bearing 4 w
  • weight-bearing 4 w

Results Koutsogiannis osteotomy

  • Correction of the valgus and the eversion force of the Achilles tendon
  • Medial arch + forefoot abduction: deformation corrected only if no severe flatfoot
  • Koutsogiannis alone not enough!

What to do for Pes Plano Valgus Tibialis Posterior Dysfunction?

  • Valgus hindfoot?
  • Forefoot abduction?
  • LLI?
  • Spring ligament ?
  • Tibialis posterior?
  • Images of valgus tibialis posterioir dysfunction

What to do if tibialis posterior tendon rupture?

Illustration of tibialis posterior tendon Z-lengthening Illustration of tibialis posterior tendon FHL/FDC transfert Illustration of tibialis posterior tendon TA transfert