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Medial Soft-Tissue Release for Lateralising Calcaneal Osteotomy: A Cadaveric Study

  • Kumar Kaushik Dash
  • Rebecca Bradley
  • Ioannis Stavrakakis
  • Kalpesh ShahEmail author
Original Article

Abstract

Background

Lateralising calcaneal osteotomy for pes cavus is generally regarded to be harder to shift than a medialising calcaneal osteotomy for pes planus. The aim of our study was to determine the structures which restrain a lateral shift.

Methods

Lateralising calcaneal osteotomy was performed on four soft-embalmed cadavers via a standard lateral approach and the lateral calcaneal shift was measured before and after the release of flexor retinaculum. Further exploratory dissection around the osteotomy site revealed the abductor hallucis muscle to be the main restraint to the lateral shift of the calcaneus. Subsequently, lateralising calcaneal osteotomy was performed on another four cadavers and the abductor hallucis muscle fascia as well as the plantar fascia was released. The lateral shift was measured before and after the fascia release, and compared with the results achieved following the flexor retinaculum release in the first four cadavers.

Results

Lateralising calcaneal osteotomy alone resulted in an average of 4.5-mm lateral shift in the first four cadaveric specimens. Releasing the flexor retinaculum led to a further 3-mm increase of lateral shift on average. In the next four cadaveric specimens, lateralising calcaneal osteotomy alone resulted in an average of 5.5-mm lateral shift. Release of abductor hallucis muscle fascia and the plantar fascia in these four specimens increased the lateral shift by an additional 7 mm on average. Hence, release of abductor hallucis muscle fascia resulted in an extra 4-mm shift on average compared with what is achieved with flexor retinaculum release.

Conclusions

Abductor hallucis muscle fascia was discovered to be one of the main structures limiting the lateral shift in lateralising calcaneal osteotomy. Release of fascia over this muscle as well as the plantar fascia should help in improving lateral shift. Further experimental and clinical research is necessary to confirm the findings of this pilot study.

Keywords

Lateralising calcaneal osteotomy Pes cavus Flexor retinaculum Abductor hallucis Plantar fascia 

Notes

Author contributions

Concepts: KKD, RB, IS, KS, Design: KKD, RB, KS, Definition of intellectual content: KKD, RB, KS, Literature search: KKD, RB, IS, KS, Experimental studies: RB, KS, Data acquisition: RB, KS, Data analysis: KKD, RB, IS, KS, Statistical analysis: KKD, Manuscript preparation: KKD, RB, IS, Manuscript editing: KKD, IS, KS, Manuscript review: KKD, RB, IS, KS, Guarantor: KS.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Indian Orthopaedics Association 2020

Authors and Affiliations

  • Kumar Kaushik Dash
    • 1
  • Rebecca Bradley
    • 2
  • Ioannis Stavrakakis
    • 3
  • Kalpesh Shah
    • 4
    Email author
  1. 1.Department of Trauma and OrthopaedicsWrexham Maelor HospitalWalesUK
  2. 2.Neonatal UnitRoyal Hospital for ChildrenGlasgowUK
  3. 3.Department of Orthopaedics and TraumatologyGeneral Hospital of Agios NikolaosCreteGreece
  4. 4.Department of OrthopaedicsGolden Jubilee National HospitalGlasgowUK

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