Benthien (2007) — Lateral column calcaneal lengthening, flexor digitorum longus transfer, and opening wedge medial cuneiform osteotomy for flexible flatfoot: a biomechanical study.

Lateral Column Calcaneal Lengthening, Flexor Digitorum Longus Transfer, and Opening Wedge Medial Cuneiform Osteotomy for Flexible Flatfoot: a Biomechanical Study.

·Foot Ankle Int·2007·93 citations·Foot & Ankle

Cadaver biomechanical study (n=8 specimens) using a reproducible severe flatfoot model to compare Evans lateral column lengthening + simulated FDL transfer alone versus the same construct with an added dorsal opening wedge medial cuneiform osteotomy, measuring both radiographic correction and pedobarographic pressure distribution across four conditions: intact, flatfoot, LCL+FDL, and LCL+FDL+MCO.

Study Snapshot

Design

Cadaveric biomechanical study

Setting: Single institution, Baltimore

Objective

Whether adding medial cuneiform osteotomy reduces lateral column overload after Evans flatfoot reconstruction

Outcome(s)

Lateral forefoot pressure and radiographic alignment after flatfoot reconstruction

Subjects

8 cadaver specimens

12Obtained
4Excluded

Exclusion

High medial arch; no flatfoot created with model (n=4)

Statistics

One-way repeated measures ANOVAPost hoc testing

Key Findings

Lateral column lengthening + FDL transfer corrected radiographic deformity (lateral talo-first MT angle -17 → -7°, talonavicular coverage 46 → 24°, cuneiform height 16 → 20 mm; all p < 0.001) but drove lateral forefoot pressure up from 24.6 to 33.9 kPa (p < 0.001) — biomechanical confirmation of clinical lateral column overload
Adding a 6-mm dorsal opening wedge medial cuneiform osteotomy reduced lateral forefoot pressure to 29.0 kPa, no longer significantly different from the intact foot (p = 0.14), while providing additional radiographic correction (angle -7 → -4°, cuneiform height 20 → 25 mm)
The combined procedure overcorrected medial forefoot pressure to 39.1 kPa — significantly above both flatfoot (32.8 kPa, p = 0.01) and intact (30.6 kPa, p < 0.001) — signaling a risk of medial column overload if the osteotomy is not sized to the individual deformity
Lateral talocalcaneal angle did not change significantly under any condition, supporting the authors' prior conclusion that this parameter is unreliable for cadaver flatfoot analysis
Radiographic overcorrection in all corrected states likely reflects use of fixed wedge sizes on all specimens; clinically, wedge size must be titrated to the degree of deformity

Clinical Relevance

When performing an Evans lateral column lengthening for stage II PTTD, expect lateral forefoot pressure to rise — if the foot supinates or the patient reports lateral column pain postoperatively, a medial cuneiform osteotomy can redistribute load effectively, but size the wedge to the deformity to avoid trading lateral overload for medial overcorrection.

Supplemental

Lateral Column Calcaneal Lengthening, Flexor Digitorum Longus Transfer, and Opening Wedge Medial Cuneiform Osteotomy for Flexible Flatfoot: a Biomechanical Study.

Benthien, Schon, et al.·Foot Ankle Int·2007·93 citations·Foot & Ankle

Lateral Column Calcaneal Lengthening, Flexor Digitorum Longus Transfer, and Opening Wedge Medial Cuneiform Osteotomy for Flexible Flatfoot: a Biomechanical Study.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Lateral Column Calcaneal Lengthening, Flexor Digitorum Longus Transfer, and Opening Wedge Medial Cuneiform Osteotomy for Flexible Flatfoot: a Biomechanical Study.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Lateral Column Calcaneal Lengthening, Flexor Digitorum Longus Transfer, and Opening Wedge Medial Cuneiform Osteotomy for Flexible Flatfoot: a Biomechanical Study.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Lateral Column Calcaneal Lengthening, Flexor Digitorum Longus Transfer, and Opening Wedge Medial Cuneiform Osteotomy for Flexible Flatfoot: a Biomechanical Study.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles