Calcaneal Osteotomy

Flatfoot, or fallen arches, can cause pain in the feet, ankles, and knees; especially later in life.A calcaneal osteotomy is a controlled break of the heel bone, performed by an orthopedic surgeon, to correct deformity of the foot and ankle that causes flatfeet. The calcaneus, or heel bone, plays an integral role in walking.  Calcaneal osteotomy involves cutting the heel bone and shifting it toward the inside (medial) or outside (lateral).  The surgery is recommended for patients whose alignment is significantly offset by flatfoot or abnormally high arches, and for whom more conservative, non-surgical therapies have failed. Alignment of the heel influences how weight-bearing stress is applied to the foot, ankle, knee and hip.Calcaneal osteotomies are a mainstay of foot and ankle surgery, and are critical in the correction of serious foot deformities.

The heel bone can be moved to achieve a different orientation, which can correct a variety of deformities and functional limitations, such as flatfoot or abnormally high arches. The main goal of all osteotomies is to relieve pain, improve alignment and walking, and reduce the risk of arthritis. There are four types of controlled breaks of the heel bone that can be performed: Evans, Dwyer, Medial Shift and Lateral Shift.  Your surgeon will evaluate your symptoms and examine your foot to determine the type of osteotomy that is appropriate for your condition.

Patients with flatfoot sometimes have an Evans osteotomy. If you look down at your foot, you can see the inside edge and the outside edge of the foot. For your foot to be straight, the inside edge 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 lengthens the outside part of the foot to help make it straight.

Patients who have lost the arch in a foot may have a medializing osteotomy. The heel bone is cut and moved to the inside part of the foot to help restore the arch.  A fallen arch can be caused by arthritis, loss of tendon function or an injury.

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.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.

Before considering a calcaneal osteotomy, patients should first attempt conservative treatment options such as immobilization, rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics or physical therapy.  However, the success of these treatments depends on the stage of the deformity, duration and severity of symptoms.

General Details of an Osteotomy

Surgery is typically performed on an outpatient basis, meaning you can go home the same day.  Anesthesia will be administered to ensure no pain during the surgical procedure. The site of the incision will be sterilized before the procedure begins.Most osteotomies are approached from the outer side of one’s foot.  Typically, an incision is made along the outside of your foot giving the surgeon access to the heel bone. The surgeon will then use a surgical cutting instrument to carefully divide the heel in two separate pieces.

The free piece of bone will be shifted in the heel to create a modified arch in the foot. Once the piece is properly aligned, the surgeon will rejoin the two pieces of calcaneus.The cut in the bone depends on the type of osteotomy being performed. Depending on the procedure, the bone is moved to the desired location and fixed in place. Finally, surgical implants such as screws hold the affected bones together and support proper healing.

Recovery

After a calcaneal osteotomy, the incision is closed and carefully bandaged and your foot is placed in a splint or boot. Depending on your surgeon’s preference, the splint may be changed to a cast at the one- or two-week follow-up. You cannot bear weight on the affected foot for 4-6 weeks, and after that point, progressive weight bearing can usually start. Your surgeon will give you post-operative instructions that outline the healing process. Getting back to regular activities can occur in the range of 3-6 months, and swelling will improve slowly.

If fallen arch pain is keeping you off your feet, and you would like a consultation to determine if you are a candidate for a calcaneal osteotomy, please call us at 718.873.3174 to schedule an appointment at one of our convenient locations in Brooklyn, Queens, or Manhattan.