Henry Jensen K, Hoffman Jeffrey K, Kim Jaeyoung, Lu Kira, Steineman Brett, Demetracopoulos Constantine, Deland Jonathan, Ellis Scott
Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA.
Biomechanics Department, Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2025 Sep;46(9):1030-1038. doi: 10.1177/10711007251351308. Epub 2025 Jul 11.
Calcaneal osteotomies are often used to correct hindfoot valgus and forefoot abduction in patients with PCFD. Calcaneal osteotomies are commonly performed to address hindfoot valgus and forefoot abduction present with PCFD. This study compared the dynamic effects of medializing calcaneal osteotomy (MCO) and lateral column lengthening (LCL), after simulated PCFD (sPCFD), on joint kinematics and plantar pressure during simulated gait.
Twelve cadaveric mid-tibia specimens were loaded on a 6-degree-of-freedom robotic gait simulator. Gait was simulated first in the intact and sPCFD conditions. After sPCFD testing, surgical reconstruction and testing was performed in stages with MCO and LCL (6- and 8-mm grafts). Ankle, subtalar, and talonavicular joint kinematics and plantar pressures were collected, and differences compared between the intact, sPCFD, and surgically corrected conditions.
The isolated MCO partially corrected foot kinematics, and notably increased talar dorsiflexion throughout the stance. The isolated LCL restored ankle kinematics, but subtalar eversion and talonavicular abduction were still uncorrected during stance. However, LCL and MCO together were able to restore talonavicular kinematics throughout stance to normal levels. Larger LCL graft size further improved foot kinematics, but resulted in overcorrection in the subtalar and ankle joints during portions of stance. All procedure combinations increased lateral plantar pressure relative to the sPCFD condition.
Isolated MCO and LCL, and a combination of both, all partially restored ankle and hindfoot joint kinematics. However, overcorrection in certain planes of motion and increased lateral plantar pressure suggest a risk of lateral column overload as LCL graft size increases.
The synergistic effect of MCO and LCL may be effective at restoring kinematics, but surgeons should be cautious in increasing osteotomy size at the lateral column to avoid overload. Gait simulation may help us learn how to titrate combinations of corrections that best restore kinematics-and ultimately, improve clinical outcomes.
跟骨截骨术常用于矫正小儿麻痹后遗症（PCFD）患者的后足外翻和前足外展。跟骨截骨术通常用于解决PCFD患者出现的后足外翻和前足外展问题。本研究比较了模拟PCFD（sPCFD）后，内侧移位跟骨截骨术（MCO）和外侧柱延长术（LCL）对模拟步态期间关节运动学和足底压力的动态影响。
将12个尸体胫骨中段标本加载到一个6自由度的机器人步态模拟器上。首先在完整状态和sPCFD状态下模拟步态。在sPCFD测试后，分阶段进行MCO和LCL（6毫米和8毫米移植物）的手术重建和测试。收集踝关节、距下关节和距舟关节的运动学数据以及足底压力，并比较完整状态、sPCFD状态和手术矫正状态之间的差异。
单独的MCO部分矫正了足部运动学，并且在整个站立期显著增加了距骨背屈。单独的LCL恢复了踝关节运动学，但在站立期距下关节外翻和距舟关节外展仍未得到矫正。然而，LCL和MCO一起能够在整个站立期将距舟关节运动学恢复到正常水平。更大尺寸的LCL移植物进一步改善了足部运动学，但在站立期的部分阶段导致距下关节和踝关节过度矫正。相对于sPCFD状态，所有手术组合均增加了足底外侧压力。
单独的MCO和LCL以及两者的组合均部分恢复了踝关节和后足关节运动学。然而，在某些运动平面的过度矫正和足底外侧压力增加表明，随着LCL移植物尺寸的增加，存在外侧柱过载的风险。
MCO和LCL的协同作用可能对恢复运动学有效，但外科医生在增加外侧柱截骨尺寸时应谨慎，以避免过载。步态模拟可能有助于我们了解如何调整最佳恢复运动学的矫正组合，最终改善临床结果。
