The hind- and midfoot alignment computed after a medializing calcaneal osteotomy using a 3D weightbearing CT

  • Arne BurssensEmail author
  • Alexej Barg
  • Esther van Ovost
  • Aline Van Oevelen
  • Tim Leenders
  • Matthias Peiffer
  • Irina Bodere
  • Weightbearing CT International Study Group (WBCT ISG)
  • Emmanuel Audenaert
  • Jan Victor
Original Article



A medializing calcaneal osteotomy (MCO) is a surgical procedure frequently performed to correct an adult acquired flatfoot (AAFD) deformity. However, most studies are limited to a 2D analysis of 3D deformity. Therefore, the aim is to perform a 3D assessment of the hind- and midfoot alignment using a weightbearing CT (WBCT) preoperatively as well as postoperatively.


Eighteen patients with a mean age of 49.4 years (range 18–67) were prospectively included in a pre–post-study design. A MCO was performed and a WBCT was obtained pre- and postoperative. Images were converted into 3D models to compute linear and angular measurements, respectively, in millimeters (mm) and degrees (°), based on previously reported landmarks of the hind- and midfoot alignment. A regression analysis was performed between the displacement of a MCO and the obtained postoperative correction.


The mean 3D hindfoot angle improved significantly preoperative compared to postoperative (p < 0.001). This appeared according to a linear relation with the amount of medial translation in a MCO (R2 = 0.84, p < 0.001). The axes of the tibia showed significant coronal as well as axial changes (p < 0.05). Analysis of the midfoot showed significant changes in the navicular height and rotation as well as the Méary angle (p < 0.05). Additionally, a linear trend between the midfoot measurements and amount of medial translation in a MCO was observed, but not significant (p > 0.05).


This study demonstrates an effective 3D correction of an AAFD by a MCO according to a linear relationship. The concomitant formula can be used to perform a preoperative planning. The novelty is the comparative 3D weightbearing CT assessment of both the computed hind- and midfoot alignment after a medializing calcaneus osteotomy. This could improve accuracy of the currently performed preoperative planning in clinical practice.


Medializing calcaneal osteotomy Computed pre- and postoperative assessment Weightbearing CT Adult acquired flatfoot deformity 



The authors wish to thank Maxwell Weinberg, as a research coordinator at the University Orthopaedic Center of Utah for his attributive linguistic and structural support. The authors would like to thank Dr. Stephanie De Buyser, as a statistician at the University Hospital of Ghent for her statistical review.

Weightbearing CT International Study Group actively contributing members are as follows: Richter M, Barg A, Lintz F, de Cesar Netto C, Burssens A and Scott J. Ellis.


This work was supported by a grant from the Clinical Research Fund University Hospital of Ghent, Belgium, Klinisch Onderzoeks Fonds (KOF; #KW/1594/ORT/001/001) and Fonds voor Wetenschappelijk Onderzoek (FWO; #V424118 N).

Compliance with ethical standards

Conflict of interest

Arne Burssens, MD, performed a paid consultancy for Curvebeam outside the submitted work. Alexej Barg, MD, has nothing to disclose. Esther van Ovost, BMSc, has nothing to disclose. Aline Van Oevelen, BMSc, has nothing to disclose. Tim Leenders, MD, has nothing to disclose. Matthias Peiffer, MD, has nothing to disclose. Irina Bodere, Ir has nothing to disclose. WBCT ISG receives logistic funding from Curvebeam, Planmed and Carestream outside the submitted work. Emmanuel Audenaert, MD, PhD, has nothing to disclose. Jan Victor, MD, PhD has nothing to disclose.

Supplementary material

11548_2019_1949_MOESM1_ESM.tif (157 kb)
Supplementary material 1 (TIFF 157 kb)
11548_2019_1949_MOESM2_ESM.tif (270 kb)
Supplementary material 2 (TIFF 270 kb)


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Copyright information

© CARS 2019

Authors and Affiliations

  • Arne Burssens
    • 1
    • 2
    Email author
  • Alexej Barg
    • 3
  • Esther van Ovost
    • 2
  • Aline Van Oevelen
    • 2
  • Tim Leenders
    • 3
  • Matthias Peiffer
    • 2
  • Irina Bodere
    • 2
  • Weightbearing CT International Study Group (WBCT ISG)
  • Emmanuel Audenaert
    • 2
  • Jan Victor
    • 2
  1. 1.Department of Orthopaedics and Traumatology, University Hospital of UtahUniversity of UtahSalt Lake CityUSA
  2. 2.Department of OrthopaedicsGhent University HospitalGhentBelgium
  3. 3.Department of OrthopaedicsAZ Monica HospitalDeurneBelgium

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