Trial Wedges Can Lessen Pain After Lateral Column Lengthening for Flatfoot Deformity

NATIONAL HARBOR, Md. — Lateral column lengthening for
flatfoot deformity correction can be used safely, albeit with
a risk of postsurgical plantar lateral discomfort. However, the use of
intraoperative trial wedges may decrease that complication, according to
investigators from New York.

  Scott J. Ellis
  Scott J. Ellis

“Lateral column lengthening helps restore the longitudinal arch and
is usually used in our practice when the medial calcaneal osteotomy does not
give enough correction,” Scott J. Ellis, MD, said at the 2010 Summer
Meeting of the American Orthopaedic Foot and Ankle Society. “However there
is a controversy over the potential risk of overloading the lateral side of the

Also, he noted that a literature review reported that up to 45% of
patients had pain or discomfort following lateral column lengthening

Ellis and colleagues at the Hospital for Special Surgery wanted to
12 mm,” Ellis said. “We started using them in January 2006 and the
technique is to titrate the amount of lengthening that was can be performed
until enough tensioning of the talar-navicular joint was seen in an AP view so
that there was enough correction and abduction, but also to avoid stiffness and
hindfoot eversion.”

All of the outcomes scores in the pain group were equal between the
groups, he said. “There was no difference between the pain and no pain
groups in the radiographic parameters.”

He reported that there were also no differences in graft size between
the groups with pain and no pain. “In fact the average graft size was
similar in both groups 6.9 mm vs. 6.8 [respectively],” he said.

Also, “the amount of discomfort in the cohort overall was 11.2%,
the incidence before the wedges was 14.7%,” he said noting the use of the
wedges may have lowered this complication rate.

“The senior author was very aggressive about urging patients to
undergo revision if they had pain and the overall rate of revision was 9.1%
before wedges and afterward it was 3.7,” he said. — by Lee

For more information:

  • Ellis S, Garg R, Campbell G, et al. Plantar lateral discomfort
    after lateral column lengthening in flatfoot reconstruction. Presented at the
    2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. July
    8-10, 2010. National Harbor, Md.

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