ArticleJBJS essential surgical techniques
Evans and Cotton Osteotomies Using Porous Titanium Wedges to Correct Pediatric Flatfoot Deformity.
Article in JBJS essential surgical techniques. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The present video article demonstrates the use of Evans and Cotton osteotomies with porous titanium wedges for the treatment of pediatric flatfoot. Pediatric flatfoot is not commonly painful or disabling and usually resolves as the arch elevates spontaneously. However, in cases of flatfoot that persist despite nonoperative treatment, symptoms such as severe activity-related pain and medial foot calluses are an indication for surgical intervention Description: Reconstruction of the foot is achieved by performing a lateral column lengthening calcaneal osteotomy (i.e., Evans osteotomy) Alternatives: Numerous other surgical techniques have been described for the treatment of flatfeet Rationale: The combination of Evans and Cotton osteotomies ensures restoration of the functional integrity of the medial longitudinal arch through lengthening of the lateral column, resulting in correction of forefoot abduction and hindfoot valgus while adjunctively plantar flexing the medial column. The combined use of these osteotomies demonstrates greater preservation of mobility compared with both subtalar arthrodesis and arthroereisis. Studies have shown good results over long-term follow-up Expected Outcomes: The long-term expectation is that correction of the deformity will reduce pain while restoring function of the subtalar joint. Studies assessing the use of titanium wedges for Cotton and Evans osteotomies have shown both good improvement in radiographic features and improvement of pain. With Evans osteotomies, pain (measured with use of a visual analogue scale) improved from 5.45 to 2.43 postoperatively, and postoperative Foot and Ankle Ability Measure Activities of Daily Living and Sports scores improved to 80.45 and 58.5 Important Tips: Rule out tarsal coalition with use of preoperative MRI. If present, resection can be performed and combined with Evans and Cotton osteotomies either at the same time or as a staged procedure.Careful dissection is paramount in order to avoid damaging the sural nerve while approaching the calcaneocuboid joint.Avoid "overstuffing" by ensuring appropriate sizing of the wedge.Take care to perform a good skin closure because lateral column lengthening always "tenses" the lateral foot. Acronyms and Abbreviations: LCL = lateral column lengtheningCCJ = calcaneocuboid jointII = image intensifierAP = anteroposteriorMRI = magnetic resonance imagingK-wire = Kirschner wireTA = tendon AchillesCT = computed tomography.
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