Akin截骨联合第一跖骨基底楔形植骨治疗中重度足拇外翻

目的 观察远端软组织松解、Akin截骨联合第一跖骨基底开放截骨楔形植骨治疗中重度足拇外翻畸形的疗效.方法 对16例(24足)中重度足拇外翻患者行第一跖骨远端软组织松解、近节趾骨Akin截骨、第一跖骨基底内侧开放截骨后将Akin截骨楔形骨块植入并用克氏针固定.结果 第一、二跖间角由术前16°～20°矫正至术后8°～11°(平均矫正7.6°),足拇外翻角由术前37°～43°矫正至术后9°～15°(平均矫正21.2°),差异有统计学意义(P＜0.05).Maryland足功能评分结果显示,优18足,良5足,可1足,优良率为95.8％.结论 远端软组织松解、Akin截骨联合第一跖骨基底开放截骨楔形植骨治疗中重度足拇外翻畸形的疗效可靠.     

跟骨内移截骨治疗获得性扁平足临床分析

[目的]探讨跟骨内移截骨治疗扁平足的要点及临床疗效.[方法]自2006年1月～2009年12月,采取跟骨内移截骨及联合手术治疗扁平足3l例,男17例,女14例;年龄19～50岁(平均26.7岁).术前均摄足侧位及跟骨轴位X线片及跟骨CT,测量第1跖距角5°～32°(平均22.3°).均有跟腱挛缩、外移、跟骨外翻、前足旋前外展(负重位外观),有疼痛,根据美国矫形足踝协会(AOFAS)踝后足评分标准评分平均45.8分.胫后肌腱功能不全均二级.单纯跟骨内移截骨13例,跟骨内移截骨加跟腱延长4例,跟骨内移截骨加跟腱延长及趾长屈肌腱移位14例.[结果]术后随访6～26个月(平均18.8个月),内侧纵弓较手术前增加,内侧柱高度由术前(8.5±3.2)mm增至(16.3±4.1)mm(t=8.35,P≤0.001),10例疼痛消失,15例减轻,6例无明显改变.第1跖距角由术前5°～32°(平均22.3°±4.5°)降至0°～7°(平均3.2°±1.4°) (t=22.57,P≤0.001).足外翻及外展明显改善,有效率80.6%(25/31),(AOFAS)踝后足评分平均84.5分.[结论]跟骨体部截骨手术治疗可屈性平足疗,能够可靠地纠正平足症的跟骨外翻畸形,部分恢复其内侧纵弓,改善足的负重和足踝部生物力学特性,术中根据情况联合其他术式提高疗效,同时应严格掌握适应证.     

Akin截骨术在拇外翻手术应用的探讨

背景：Akin截骨术能够纠正拇外翻手术中残留拇趾畸形但也存在并发症,总结探讨在拇外翻手术时联合应用Akin截骨治疗拇外翻的临床疗效并探讨使用指征。 方法：总结分析2006年10月至2010年10月,在拇外翻手术时联合应用Akin截骨术48足,软组织手术加Akin截骨术6足,chevon截骨术加Akin截骨术29足,跖骨基底截骨加Akin截骨术8足,第一跖楔关节融合加Akin截骨术5足。 结果：所有病例均获得随访,随访时间6个月至5年,平均30．3个月,未见拇外翻复发病例。术前拇外翻角为37．2°±8．9°,IMA为16．5°±6．7°;术后拇外翻角为13±6．8°,IMA为8．9°．±4．5°。术前AOFAS评分为（43±10．5）分,术后为（84±7．8）分,具有统计学意义。 结论：在拇外翻手术时,根据趾骨畸形情况联合应用Akin截骨术可以降低拇外翻手术复发率,临床效果确切,但需要严格掌握手术适应证。     

改良Ludloff截骨术的几何形态学基础及其临床应用

目的 探讨Ludloff截骨术治疗母外翻后出现跖骨短缩、抬高及远端旋转的解决方案.方法 30例正常足,摄足部正侧位X线片,测量第一跖骨的长度及矢状面截骨角.计算在不同截骨条件下跖骨的抬高、短缩及旋前的理论值.根据该理论值,设计Ludloff截骨术的手术方案治疗??外翻.18例23足??外翻患者,如第一跖骨头内旋<3°,行单纯Ludloff截骨术;内旋角度为3°~6°,需行有冠状面截骨角的Ludloff截骨术;内旋角度>6°,行基底在外侧的楔形截骨;其中8足同时行第一跖骨远端截骨术以矫正跖骨远端关节角.采用??趾跖趾-趾间关节评分表及二至五趾跖趾-趾间关节评分表(AOFAS)进行疗效评定.结果 正常足第一跖骨的长度为4.60~6.90cm,平均(6.09±0.43)cm;矢状面截骨角为20.7°~31.3°,平均25.58°±2.73°.18例患者均获得随访,随访时间6~24个月,平均18个月.??趾跖趾-趾间关节评分:90~100分18足(78%),80~89分3足(13%),70~79分足2例(9%),评分平均增加36分(术前56分,术后92分);二至五趾跖趾-趾间关节评分:90~100分5足(22%),80~89分7足(30%),70~79分11足(48%),评分平均增加21分(术前59分,术后80分).结论 根据??外翻患者第一跖骨头不同的内旋角度,选取有冠状面截骨角或有基底在外侧的楔形截骨的Ludloff截骨术,可取得较理想的临床疗效.     

"双楔形"植骨距下关节融合术治疗复杂跟骨骨折畸形愈合

目的 探讨采用距下关节"双楔形"植骨距下关节融合术治疗复杂跟骨骨折畸形愈合的疗效.方法 回顾性分析2004年4月至2007年12月收治且获得完整随访的26例跟骨骨折畸形愈合Stephen Ⅲ型患者资料,男21例,女5例;年龄23～55岁,平均32.2岁;左足15例,右足11例.其中22例为后足内翻畸形,4例为外翻畸形.26例患者采用距下关节"双楔形"撑开植骨融合术进行治疗,术中行跟骨外侧壁骨赘切除及腓骨肌腱松解;撑开距下关节并刮除软骨关节面,植入前低后高,外侧低内侧高(双楔形)的三层皮质的自体髂骨;再用2～3枚空心钛钉固定距下关节.比较手术前、后距骨第一跖骨角及距骨跟骨角、美国足踝外科协会(AOFAS)踝与后足评分及视觉模拟评分(VAS).结果 26例患者术后获得平均18.9个月(12～38个月)随访.其中23例跟骨内外翻畸形明显改善,22例患足疼痛消失或明显减轻,未发生融合失败.3例切口皮缘坏死,经短期换药愈合.距骨第一跖骨角自术前17.40±2.90改善至术后6.1°±1.60°距骨跟骨角南术前16.2°±2.5°啵善至术后23.7±°3.0°,AOFAS评分自术前(34.8±8.2)分升至术后(83.9±7.0)分,疼痛评分自术前(7.8±0.7)分降至术后(2.1±1.5)分,以上指标手术前、后比较差异均有统计学意义(P<0.05).结论 "双楔形"撑开植骨距下关节融合术可明显改善跟骨内外翻畸形及疼痛症状,避免了复杂的跟骨截骨移位术.该术式并发症较少,是治疗复杂跟骨骨折畸形愈合的较好选择.     

第1跖骨基底斜行闭合截骨治疗中重度(足母)外翻畸形

[目的] 回顾性研究第1跖骨基底长斜行闭合截骨治疗足母外翻的临床效果.[方法]2007年2月～2008年11月间行第1跖骨基底长斜形截骨结合远端软组织松解内侧关节囊重叠缝合治疗<足母>外翻共21例24足,均属中重度足母外翻,第1、2跖间角均大于15°,行第1跖骨基底斜行闭合截骨螺钉内固定术.[结果]平均随访7.6个月,术前平均HVA、IM 1-2角分别为31.30°±6.68°和16.62°±2.65°,术后平均HVA、IM 1-2角分别为12.96°±7.15°和9.80°±2.43°,平均矫正HAV角19.6°、IM角8.2°,术前、术后平均有明显统计学差异(P<0.001),第1跖骨长度与第2跖骨长度比术前、术后分别为(89±6.7)%、(84±5.6)%,有明显统计学差异(P<0.05).[结论] 第1跖骨基底长斜形闭合截骨手术方法治疗中重度<足母>外翻畸形可以取得比较好的矫正结果.     

Weil截骨治疗(足母)外翻转移性跖痛

[目的]回顾分析Weil截骨治疗(踇)外翻转移性跖痛的疗效.[方法]自2004年至200:5年联合应用第1跖骨基截骨及Weil截骨治疗伴有外侧跖骨头转移性跖痛的中重度外翻17例25足.患足手术前后常规拍摄足正侧位片,测量足母外翻角(HVA),I-Il跖骨间角(IMA),使用美国足踝外科协会(踇)趾-跖趾-趾间关节评分系统(AOFAS)评分评估临床疗效.手术方法根据患者术前症状选择第1跖骨基底截骨联合外侧跖骨头Weil截骨.[结果]患者(踇)外翻角(HVA)术前为32°±5.7°,术后为12.8°±3.5°;Ⅰ-Ⅱ跖骨间角(IMA)术前为23.2°±3.7°,术后为10.5°±0.7°;AOFAS评分术前45.6±6.9分,术后86.9±4.6分;Weil截骨术后的跖骨短缩3-8 mm,平均4.5 mm;术后18足跖痛症状完全缓解,7例好转,所有患者日常生活正常,无需进一步治疗.[结论] (踇)母外翻术前应综合分析足部的生物力学变化,对伴有外侧转移性跖痛的严重(踇)外翻患者,联合使用第1跖骨基截骨和外侧跖骨头Weil截骨可获得良好疗效.     

经皮Chevron截骨术治疗轻中度足拇外翻畸形

目的评估经皮Chevron截骨术治疗轻中度足拇外翻畸形的疗效。方法 2010年6月至2012年5月,采用经皮Chevron截骨术治疗24位(26例)轻中度足拇外翻患者。所有患者均为女性,平均年龄48岁,其中右足14例,左足12例。术前和末次随访时测量足拇外翻角、跖骨间角,并进行美国足踝骨科学会(AOFAS)前足评分。术前足拇外翻角20°~40°,跖骨间角小于20°,跖骨远端关节角小于10°。结果术后平均随访26.3个月,足拇外翻角由术前平均31.68°纠正至术后平均14.39°,跖骨间角由术前平均13.77°纠正至术后平均7.98°,AOFAS前足评分由术前平均59.26分改善至术后平均88.35分。术后4例出现内侧关节囊折叠缝合引起的刺激症状,4例出现螺钉尾端刺激症状,但无伤口感染、关节僵硬及跖骨头坏死等并发症发生。结论经皮Chevron截骨术中期随访结果较好,可有效治疗轻中度足拇外翻畸形。     

改良Mitchell手术治疗外翻的疗效分析

目的观察改良Mitchell手术治疗外翻的疗效。方法自1998年3月～2001年10月对20例(39足)外翻患者行改良Mitchell手术。术前摄负重位X线片,测量HVA平均为29.5°,IMA平均为12.5°。本术式与传统Mitchell手术不同的是在第一跖骨远端只行一次横行截骨,不留外侧棘,根据IMA的大小决定截骨远端外移的多少,再向跖侧移位2~3mm,用可吸收螺钉固定。结果随访38足,随访时间为11~38个月,平均31个月,优32足,良5足,差1足,优良率为97.4%。术后负重位X线片测量,HVA平均为14.5°,平均改善15°;IMA平均为8.5°,平均改善4°。结论改良Mitchell手术可矫正第一跖骨内翻,更重要的在于矫正畸形而不破坏趾的生物力学作用,第一跖骨头的跖侧移位,重建了足横弓,恢复了趾的负重功能。     

肱骨髁上楔形截骨加"8"字钢丝固定治疗肘内翻畸形

目的评价肱骨髁上楔形截骨加桡侧“8”字钢丝张力带固定在肘内翻畸形矫正中的应用价值及临床疗效。方法2002年4月～2005年10月,对17例肘内翻患者经肘关节外侧小切口暴露肱骨远端,于肱骨髁上行顶端朝向内侧的楔形截骨加桡侧“8”字钢丝张力带固定,术后屈肘中立位上肢石膏托固定,4周后拆石膏进行功能锻炼。结果所有患者术后随访1．5～3．0年,平均2．1年,截骨部位均于术后6～10周获骨性愈合,10～12周关节活动度恢复至术前水平。术侧提携角由术前平均内翻22．4°恢复至术后平均外翻10．2°,随访末期2例矫正度数有少许丢失,分别为2°及4°。按巴英伟制定的标准进行功能评价,优15例,良2例,优良率为100%。结论肱骨髁上楔形截骨加桡侧“8”字钢丝张力带固定治疗肘内翻具有切口小、操作简单、固定确实、软组织刺激少及术中便于调整截骨角度等优点,患者可早期进行功能锻炼,较快恢复关节活动度。     

Idiopathic cavovarus and lateral ankle instability: recognition and treatment implications relating to ankle arthritis

Hindfoot malalignment and chronic lateral ankle instability may lead to degenerative ankle arthritis. We retrospectively analyzed 10 patients with 13 cavovarus feet. None of the patients had underlying neurologic disorders. All patients presented with a history consistent with chronic lateral ankle instability, clinically with cavovarus feet, and radiographically with varying degrees of varus talar tilt and ankle arthritis. Ankles with severe degenerative change were fused. The ankles with mild or moderate change underwent calcaneal osteotomy with lateral ligament reconstruction and/or dorsiflexion osteotomy of the first metatarsal. A quantitative radiographic Coleman block test was utilized to aid in the preoperative planning of the calcaneal and metatarsal osteotomies. All patients had correction of preoperative deformity and resolution of pain and instability. Recognition of the association between cavovarus and chronic ankle instability and degenerative ankle arthritis may be important in developing the appropriate treatment strategy in this patient population.     

Effectiveness of calcaneal osteotomy in surgical treatment of foot conditions: A Prisma statement guidelines compliant systematic review

Calcaneal osteotomy is a commonly established method used to correct various foot malalignment surgery problems that produce varus and valgus hindfoot abnormality as well as Haglund''s deformity, cavovarus foot reconstruction, flatfoot deformity, plantar fasciitis, posterior tibial tendon insufficiency and planovalgus foot. After decades, several procedures in orthopaedic foot surgery have been suggested for reducing the risk of wound and neurovascular complications. The goal of this Prisma statement guidelines compliant systematic review was to establish the effectiveness and safety of calcaneal osteotomy in foot surgery. We have performed a novel systematic review of the current published literature in order to evaluate the scientific evidence now available on this association, assigning predefined exclusion and inclusion criteria. Eight investigations were selected which had 191 cases. The adult flatfoot, tibialis posterior reconstruction and cavovarus foot deformity were treated with different procedures of calcaneal osteotomy techniques. The adequate level of effectiveness of calcaneal osteotomy is associated with the kind and location of the incision, with or without screw application, in each specific foot condition. There is a limited number of scientific investigations of the effectiveness and safety of the different kinds of calcaneal osteotomy in foot surgery, and there is the need to enhance outcome knowledge on this foot surgery technique.     

Total ankle arthroplasty in valgus ankle osteoarthritis

Ankle osteoarthritis (OA) is often associated with deformities. Valgus OA is less frequent than varus OA and causes of valgus OA include medial ligament instability, flat foot and posttraumatic situations, e.g. fractures of the fibula or lateral tibial plafond. The importance of the mechanical axis is generally accepted in orthopedic surgery. In cases of implantation of total ankle replacements the normal biomechanics need to be restored in order to have a correct and pain-free functioning total ankle replacement both in the short and long-term. The two most important criteria are (1) an anterior tibio-talar angle of about 90° and (2) a neutral hindfoot position. The hindfoot position is measured with the hindfoot alignment view according to Saltzman. In this view, healthy feet are in neutral or minimal varus position of 1-2° and not in a valgus position as generally assumed. The following operative steps are performed depending on the degree and localization of the valgus deformity: (1) total ankle replacement, (2) supramalleolar or (3) inframalleolar osteotomy/arthrodesis, (4) medial ligament repair, (5) fibula osteotomy and (6) syndesmotic reconstruction.     

Adult cavovarus foot

Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.     

Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot

Introduction Flat foot and/or metatarsal primus varus are the major causes of hallux valgus, and it is important to correct these deformities in order to prevent the recurrence of this condition. We demonstrate the clinical and radiological assessment of the correction of hallux valgus, metatarsal primus varus, and flat foot after proximal oblique-domed osteotomy of the metatarsus with distal soft tissue reconstruction. Materials and methods Twenty-seven feet of 22 patients with moderate or severe hallux valgus who had undergone proximal oblique-domed osteotomy were studied. After the adductor hallucis tendon was cut at the attachment of the proximal phalanx and at the sesamoid bone, the osteotomy was performed 3 cm dorsal-distal to the metatarsocuneiform joint to transfer distal fragment approximately 5 mm in the plantar direction, and rotated laterally decreasing the first–second intermetatarsal angle to 5 degrees. Results The mean AOFAS score was 54.1 ± 2.8 points at pre-operation and 92.8 ± 4.8 points at the most recent follow-up (P < 0.0001). Significant improvement was seen between the hallux valgus angle (P < 0.0001), first–second intermetatarsal angle (P < 0.0001), first–fifth intermetatarsal angle (P < 0.0001), talar pitch (P = 0.0032), and calcaneal plantar angle (P = 0.0327) before surgery and at one year after surgery. The average improvement of the talar pitch and calcaneal plantar angle was 2.6 ± 1.4 and 2.4 ± 1.5 degrees, respectively. Conclusion This study suggest that proximal oblique-domed osteotomy of the metatarsal as a surgical procedure for the treatment of moderate or severe hallux valgus with flat foot can be recommended to correct the longitudinal arch of the foot and the first–second intermetatarsal angle.     

Plantarflexion opening wedge medial cuneiform osteotomy for correction of fixed forefoot varus associated with flatfoot deformity

BACKGROUND: Flatfoot presents as a wide spectrum of foot deformities that include varying degrees of hindfoot valgus, forefoot abduction, and forefoot varus. Medial displacement calcaneal osteotomy, lateral column lengthening, and subtalar fusion can correct heel valgus, but may not adequately correct the fixed forefoot varus component. The purpose of this study was to determine the effectiveness of plantarflexion opening wedge medial cuneiform (Cotton) osteotomy in the correction of forefoot varus. METHODS: Sixteen feet (15 patients) had plantarflexion opening wedge medial cuneiform osteotomies to correct forefoot varus associated with flatfoot deformities from several etiologies, including congenital flatfoot (six feet, average age 37 years), tarsal coalition (five feet, average age 15 years), overcorrected clubfoot deformity (two feet, ages 17 years and 18 years), skewfoot (one foot, age 15 years), chronic posterior tibial tendon insufficiency (one foot, 41 years), and rheumatoid arthritis (one foot, age 56 years). RESULTS: Standing radiographs showed an average improvement in the anterior-posterior talo-first metatarsal angle of 7 degrees (9 degrees preoperative, 2 degrees postoperative). The talonavicular coverage angle improved an average of 15 degrees (20 degrees preoperative, 5 degrees postoperative). The lateral talo-first metatarsal angle improved an average of 14 degrees (-13 degrees preoperative, 1 degree postoperative). Correcting for radiographic magnification, the distance from the mid-medial cuneiform to the floor on the lateral radiograph averaged 40 mm preoperatively and 47 mm postoperatively (average improvement 7 mm). All patients at followup described mild to no pain with ambulation. There were no nonunions or malunions. CONCLUSIONS: Opening wedge medial cuneiform osteotomy is an important adjunctive procedure to correct the forefoot varus component of a flatfoot deformity. Advantages of this technique in comparison to first tarsometatarsal arthrodesis include predictable union, preservation of first ray mobility, and the ability to easily vary the amount of correction. Because of the variety of hindfoot procedures done in these patients, the degree of hindfoot correction contributed by the cuneiform osteotomy alone could not be determined. We have had excellent results without major complications using this technique.     

Dwyer's calcaneal osteotomy for varus deformity of the foot. (A follow-up study including gait analysis) (author's transl)]

A follow-up study on 20 patients one to 9 years after lateral wedge resection of the calcaneus according to Dwyer is reported. In 18 feet with neurogenic varus deformity of the hind foot, the angle between the axis of the lower leg and the heel was altered from 11.4 degrees +/- 1.4 degrees SD varus to a normal value of 5.9 degrees +/- 0.9 degrees SD valgus. The position of the calcaneal tuberosity was changed from 6.7 degrees +/- 1.1 degree SD varus to 0.1 degree +/- SD varus in 7 congenital club feet. The osteotomy reduced accompanying deformities of pes cavus and pes adductus in the operated children.     

Basal osteotomy with lateral soft tissue release and medial plication in the correction of moderate to severe hallux valgus

Moderate and severe hallux valgus usually consists of metatarsus varus and incongruency of the joints. Basal osteotomy and distal soft tissue release provides adequate correction of intermetatarsal angle (IMA) and joint alignment.This is a retrospective study of 26 feet in 20 patients. American Orthopaedics Foot and Ankle Society Score (AOFAS) and subjective grading system for patient's satisfaction were used for assessment. The surgical technique consisted of crescentic basal osteotomy, lateral distal soft tissue release and medial capsular plication according to Roger Mann. Fourteen osteotomies were fixed with K wires and Barouk Screws were used in 12 feet. Patients were mobilised in high heeled shoe post-operatively.Average age was 55.2 years and average follow-up was 25.8 months. The average preoperative hallux valgus angle (HVA) and IMA were 37.38 and 17.27°, respectively. The average post-operative HVA and IMA were 13.3 and 6.4°, respectively. All incongruent joints became congruent after surgery. Sesamoid position improved in 25 feet. Average AOFAS score was 88.8. Ninety-four percent patients were highly satisfied.Complications included breakage of K wire in one leading to change in practice, decreased sensations over medial side of toe in three and mild metatarsalgia in one foot.Basal osteotomy with distal soft tissue release provides good correction of moderate to severe deformity and has high patient satisfaction. Barouk screw provides stable fixation.     

Sprunggelenkprothese bei Valgusarthrose

Ankle osteoarthritis (OA) is often associated with deformities. Valgus OA is less frequent than varus OA and causes of valgus OA include medial ligament instability, flat foot and posttraumatic situations, e.g. fractures of the fibula or lateral tibial plafond. The importance of the mechanical axis is generally accepted in orthopedic surgery. In cases of implantation of total ankle replacements the normal biomechanics need to be restored in order to have a correct and pain-free functioning total ankle replacement both in the short and long-term. The two most important criteria are (1) an anterior tibio-talar angle of about 90° and (2) a neutral hindfoot position. The hindfoot position is measured with the hindfoot alignment view according to Saltzman. In this view, healthy feet are in neutral or minimal varus position of 1?C2° and not in a valgus position as generally assumed. The following operative steps are performed depending on the degree and localization of the valgus deformity: (1) total ankle replacement, (2) supramalleolar or (3) inframalleolar osteotomy/arthrodesis, (4) medial ligament repair, (5) fibula osteotomy and (6) syndesmotic reconstruction.     

Different faces of the triple arthrodesis

Patients with severe pes planovalgus or cavovarus foot deformities who fail conservative treatment may require a triple arthrodesis. Modifying the triple arthrodesis to include extended bone wedge resections allows for improved correction. The goal of each procedure is to obtain a less painful, plantigrade foot, and to improve function. Additional hindfoot or midfoot osteotomies may be needed in the modified triple arthrodesis. Midfoot or forefoot cavus can be addressed with either the Japas, Cole, or Jahss osteotomies, as described above. Residual hindfoot valgus can be adequately corrected with a medial displacement osteotomy of the calcaneus. Residual hindfoot varus is preferably corrected through a lateral closing wedge calcaneal osteotomy. This allows for adequate correction without the need for bone graft or an extended medial incision in the area of the tibial neurovascular bundle. Good results have been obtained with these types of complicated reconstructive procedures.