[Show abstract][Hide abstract] ABSTRACT: The current literature shows that proper alignment of the lower extremity allows for greater function throughout the gait cycle. Therefore, realignment should be one of the primary goals in the surgical management of lower-extremity deformities and pathology. Multiplanar radiographic angular relationships should be critically evaluated to appropriately identify the level and extent of the deformity before performing realignment procedures. This article describes a systematic approach to deformity evaluation through a comprehensive radiographic assessment of the rearfoot, ankle, and lower leg.
Journal of the American Podiatric Medical Association 95(1):2-12. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Posterior calcaneal displacement and anterior calcaneal distraction osteotomies have been recommended for surgical management of flexible flatfoot deformity. We combined these procedures for surgical management of adolescent flatfoot and late stage II posterior tibial tendon dysfunction in the adult. Lateral column distraction has been shown to reduce rearfoot valgus and forefoot abduction by stabilizing the midtarsal joint. Posterior calcaneal displacement osteotomy, which results in medial translation of the tuberosity, converts the posterior muscle group from an everter to an inverter. A supinatory moment, therefore, is created about the subtalar joint axis, which results in supination during the midstance phase of gait. These procedures may be considered when calcaneal valgus, forefoot abduction, and midtarsal joint instability are clinically significant. We also include rearfoot alignment radiographs, long leg calcaneal axial radiographs, and malleolar valgus indices to further evaluate alignment of the foot, ankle, and leg. Ideal realignment is achieved when the heel is vertical in resting calcaneal stance position, the forefoot is parallel to the rearfoot in the frontal plane, and the medial column is stabilized, with elimination of forefoot abduction.
Journal of the American Podiatric Medical Association 95(1):53-9. · 0.77 Impact Factor