1 Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Foot Ankle Int. 2019 Sep;40(9):1094-1103. doi: 10.1177/1071100719853291. Epub 2019 Jun 5.
Calcaneal malunion is a common complication of nonoperative management of calcaneal fracture, which leads to a disruption of the biomechanics of the lower extremity, pain, and permanent disability. Our aim was to evaluate pain, function, and gait after combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy for patients with neglected calcaneal fractures with malunion.
Eighteen patients with malunited calcaneal fractures, varus deformity, and subtalar arthritis were operated upon and then followed up for 18 months. All cases were assessed clinically using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring the talar inclination, talocalcaneal and talus-first metatarsal angles, and talocalcaneal height; and biomechanically by measuring the stride duration, step width, comfortable speed, and ground reaction forces in relation to the body weight.
A significant improvement in AOFAS (59.8 preoperatively to 80.2 after 18 months) and VAS (61.1 preoperatively to 29.4) was found. Also, our study revealed a significant improvement in the radiographic measurements including the valgus angle, the talocalcaneal angle, the talocalcaneal height, and the talar inclination angle. The gait analysis found that the maximum loading force in the push-off phase and comfortable speed yielded a significant improvement postoperatively. However, no significant differences between the preoperative data and the final follow-up in terms of the step width, stride duration, maximum peak force during loading phase, and minimum peak force during midstance phase were found.
The combination of valgus calcaneal osteotomy, lateral wall exostectomy, and subtalar fusion resulted in pain reduction, improved function, and better gait. However, the limited bone stock for the graft used in the subtalar fusion made use of this technique in severely reduced height unadvisable.
Level IV, case series.
跟骨畸形愈合是跟骨骨折非手术治疗的常见并发症，会破坏下肢的生物力学，导致疼痛和永久性残疾。我们的目的是评估因忽视而导致畸形愈合的跟骨骨折患者，通过跗骨联合关节融合、跟骨截骨和外侧壁切除术治疗后的疼痛、功能和步态。
对 18 例有畸形愈合的跟骨骨折、内翻畸形和距下关节炎患者进行手术治疗，并随访 18 个月。所有病例均采用美国矫形足踝协会（AOFAS）和视觉模拟评分（VAS）进行临床评估；影像学测量距骨倾斜角、距跟角和距骨第一跖骨角以及距跟骨高度；生物力学测量步幅时间、步宽、舒适速度和与体重相关的地面反作用力。
AOFAS（术前 59.8 分，术后 18 个月 80.2 分）和 VAS（术前 61.1 分，术后 29.4 分）均有显著改善。此外，我们的研究还发现，在影像学测量方面，包括外翻角、距跟角、距跟骨高度和距骨倾斜角，都有显著改善。步态分析发现，在蹬离阶段的最大负荷力和舒适速度方面，术后均有显著改善。然而，在步宽、步幅时间、负荷阶段的最大峰值力和中间阶段的最小峰值力方面，术前数据与最终随访结果之间无显著差异。
跟骨外侧截骨、外侧壁切除术和距下关节融合术相结合，可减轻疼痛，改善功能，改善步态。然而，由于距下关节融合术中移植骨的骨量有限，因此不建议在严重高度降低的情况下使用这种技术。
IV 级，病例系列。
