Calcaneal Osteotomy in Brooklyn
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 flat feet. 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 Brooklyn podiatrist will evaluate your symptoms and examine your foot to determine the appropriate type of osteotomy 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 of similar length. 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 outer part of the foot to help straighten it.
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 outward to reduce the arch and improve alignment.
Before considering a calcaneal osteotomy, patients should first attempt conservative treatment options such as immobilization, rest, and ice. Nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics, or physical therapy can also be considered. However, the success of these treatments depends on the deformity’s stage, duration, and symptom severity.
General Details of a Calcaneal 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 incision site 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 outer side of your foot, providing the surgeon with access to the heel bone. The surgeon will then use a surgical cutting instrument to carefully divide the heel into 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 promote 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; after that, progressive weight-bearing can usually begin. Your surgeon will give you postoperative instructions outlining the healing process. Getting back to regular activities can take 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 whether 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. Dr. E, a reputable NYC podiatrist, has offices ready to serve you.