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, which can correct many different deformities and foot/ankle problems. For example, abnormally high or low arches can be addressed with a calcaneal osteotomy. The ultimate goals of all
osteotomies are to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis.
If your pain is worsening or you have a foot or ankle deformity that is not responding to other treatments, a calcaneal osteotomy may be part of your surgical reconstruction plan. Discuss your options 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.
In a calcaneal osteotomy, an incision is made on the outer (lateral) side of the foot. The size of the incision can vary depending on the procedure(s) performed. Your surgeon will cut the bone, move it to the desired location, and fix it in place. Most often, surgical implants such as screws hold the bones together and support healing.
The four most common types are the Evans, Dwyer, Medial Shift, and Lateral Shift.
If you look down at your foot, you can see an inside edge and 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. An Evans osteotomy
is a controlled break that makes the outside part of the foot longer to help make the foot straight. Often a bone graft is used. The procedure may be performed on patients with flatfoot deformity.
This is a break that removes an outside-based wedge of bone from the calcaneus in order to realign the foot. It is sometimes performed on patients with abnormally high arches.
In this procedure, the heel bone is cut and moved towards the inside part of the foot to help restore a fallen arch. Arthritis, loss of tendon function, and injury are some causes of a fallen arch.
This is another osteotomy for abnormally high arches. In this procedure, the heel bone 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. Physical therapy is often recommended to help in recovery.
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.
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 foot and ankle orthopaedic surgeon will discuss the
risks and benefits of surgery with you in detail.
This is uncommon and can happen approximately 5% of the time. Smoking, infection, and poor circulation all are potential risk factors. Should you choose to have surgery, your surgeon will discuss these risks with you.
After a calcaneal osteotomy, you will need to stay off of your foot for 4-6 weeks, which can affect your ability to work, drive, and perform daily activities. It is important to discuss this with your family and employer if needed when considering surgery.
Original article by Roy Kellum Jr., MD
Contributors/Reviewers: David Lee, MD; Andrew Pao, MD; Sudheer Reddy, MD
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