What Is a Calcaneal Osteotomy?
The calcaneus, or heel bone, plays an important role in walking. A calcaneal osteotomy is a controlled break of the heel bone, performed by a foot and ankle orthopaedic surgeon, to correct deformity of the foot and ankle.
The heel bone can be realigned to achieve a different orientation, which can correct many different deformities and functional limitations. For example, abnormally high or low arches are deformities that can be addressed with a calcaneal osteotomy. The ultimate goal of all osteotomies is to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis.
If you are having worsening pain or deformity of the foot and ankle that is not responding to other treatments, a calcaneal osteotomy may be part of your surgical reconstruction plan and should be discussed with your foot and ankle orthopaedic surgeon. If you are at high risk for medical complications the risks of surgery may outweigh the potential benefits.
A calcaneal osteotomy commonly is combined with other procedures to reconstruct the foot. This type of surgery usually is an outpatient procedure, meaning you can go home the same day as surgery, but will vary depending on each patient and surgeon.
An incision is made on the outer or lateral side of the foot. After the bone is cut, it is moved to the desired location and fixed in place. Most often, surgical implants such as screws hold the bones together and support healing.
The four most common types of controlled breaks of the heel bone that can be performed are the Evans, Dwyer, Medial Shift, and Lateral Shift.
Patients with flatfoot deformity sometimes have an Evans osteotomy. If you look down at your foot, you can see the inside edge of the foot and the outside edge of the foot. For the foot to be straight, the inside edge of the foot and outside edge of the foot must be similar lengths. If the foot is pointed away from the midline then the outside edge of the foot must be functionally shorter. The Evans osteotomy is a controlled break that makes the outside part of the foot longer to help make the foot straight. Often bone graft is used for this purpose.
Patients with abnormally high arches sometimes have a Dwyer osteotomy. This is a break that removes an outside-based wedge of bone from the calcaneus in order to realign the foot.
Patients who have lost the arch in a foot may have a medializing osteotomy. The heel bone is cut and moved towards the inside part of the foot to help restore the arch. Arthritis, loss of tendon function, and injury are some causes of a fallen arch.
Another osteotomy for abnormally high arches is the lateralizing osteotomy. The heel is cut and shifted to the outside to reduce the arch and improve alignment.
You will be placed in a splint or boot. Depending on your surgeon’s preference, the splint may be changed to a cast in 1-2 weeks. You will have to keep weight off your foot for 4-6 weeks. At that point, progressive weight bearing usually can start. Getting back to regular activities typically takes 3-6 months and swelling will improve slowly. If you have another foot or ankle procedure done at the same time, your recovery may be longer.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
The potential complications associated with calcaneal osteotomies are nerve and tendon injury, failure of the bone fragments to heal together, loss of correction of the deformity, painful hardware and infection. Your orthopaedic surgeon will discuss the risks and benefits of surgery with you in detail.
What are the chances that my bone will not heal?
This is uncommon and can happen approximately five percent of the time. Smoking, infection, and poor circulation all are potential risk factors. Should you choose to have surgery, your doctor will discuss these risks with you.
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