Clinical Outcomes and Static and Dynamic Assessment of Foot Posture After Lateral Column Lengthening Procedure

• Published in: Foot & ankle international 2013-05, Vol.34 (5), p.673-683
• Main Authors: Barske, Heather, Chimenti, Ruth, Tome, Josh, Martin, Elizabeth, Flemister, Adolph S., Houck, Jeff
• Format: Article
• Language: English
• Subjects: Adult; Aged; Case-Control Studies; Female; Flatfoot - physiopathology; Flatfoot - surgery; Follow-Up Studies; Foot Joints - physiology; Gait - physiology; Humans; Male; Middle Aged; Posture - physiology; Range of Motion, Articular - physiology; Treatment Outcome; Weight-Bearing - physiology
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100712471662

Background: Lateral column lengthening (LCL) has been shown to radiographically restore the medial longitudinal arch. However, the impact of LCL on foot function during gait has not been reported using validated clinical outcomes and gait analysis. Methods: Thirteen patients with a stage II flatfoot who had undergone unilateral LCL surgery and 13 matched control subjects completed self-reported pain and functional scales as well as a clinical examination. A custom force transducer was used to establish the maximum passive range of motion of first metatarsal dorsiflexion at 40 N of force. Foot kinematic data were collected during gait using 3-dimensional motion analysis techniques. Results: Radiographic correction of the flatfoot was achieved in all cases. Despite this, most patients continued to report pain and dysfunction postoperatively. Participants post LCL demonstrated similar passive and active movement of the medial column when we compared the operated and the nonoperated sides. However, participants post LCL demonstrated significantly greater first metatarsal passive range of motion and first metatarsal dorsiflexion during gait than did controls (P < .01 for all pairwise comparisons). Conclusion: Patients undergoing LCL for correction of stage II adult-acquired flatfoot deformity experience mixed outcomes and similar foot kinematics as the uninvolved limb despite radiographic correction of deformity. These patients maintain a low arch posture similar to their uninvolved limb. The consequence is that first metatarsal movement operates at the end range of dorsiflexion and patients do not obtain full hindfoot inversion at push-off. Longitudinal data are necessary to make a more valid comparison of the effects of surgical correction measured using radiographs and dynamic foot posture during gait. Level of Evidence: Level III, comparative series.