Anterior talofibular ligament lesion is associated with increased flat foot deformity but does not affect correction by lateral calcaneal lengthening

• Published in: BMC musculoskeletal disorders 2019-10, Vol.20 (1), p.496-7, Article 496
• Main Authors: Wirth, Stephan H, Viehöfer, Arnd F, Singh, Sarvpreet, Zimmermann, Stefan M, Götschi, Tobias, Rigling, Dominic, Jud, Lukas
• Format: Article
• Language: English
• Subjects: Adult; Adult acquired flatfoot; Ankle; Anterior talofibular ligament; Bone Lengthening - methods; Calcaneus - diagnostic imaging; Calcaneus - surgery; Care and treatment; Diagnostic imaging; Female; Flatfoot; Flatfoot - diagnostic imaging; Flatfoot - etiology; Flatfoot - surgery; Flatfoot correction; Follow-Up Studies; Health aspects; Humans; Lateral calcaneal lengthening; Lateral Ligament, Ankle - diagnostic imaging; Lateral Ligament, Ankle - injuries; Magnetic Resonance Imaging; Male; Middle Aged; Osteotomy - methods; Preoperative Period; Radiography; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-019-2827-2

Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening. We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs. Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening. The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.