1. Case for small group discussion
Planovalgus foot
Case for small group discussion
AOTrauma—Foot & Ankle
Module 9: Acquired flatfoot deformity
Stefan Rammelt and Hans Zwipp, DE

2. Painful deformity 72-year-old active man
Increasing pain and deformity over the previous 5 years
Predominately left side
Pain over sinus tarsi, less pronounced on medial side

3. Preoperative x-rays

4. Correction—lateral column lengthening
Principle:
Reference:
Hansen ST Jr. Functional Reconstruction of the Foot and Ankle.  Philadelphia: Lippincott Williams & Wilkins; 2000.

5. Operative technique Fixation of anterior process (K-wire) Osteotomy
Distraction
Control of alignment
Bone block interposition
Screw fixation

6. Radiographic parameters
Preoperative x-ray
Talometatarsal (TMT) axis (lateral view)
MT V-to-cuneiform I distance
Navicular-to-floor distance (NFD)
30°
14 mm
-1 mm
Follow-up x-ray 8°
29 mm
8 mm

7. Radiographic parameters
Preoperative x-ray
Follow-up x-ray
TMT axis (AP view)
Talonavicular (TN) coverage angle, TN coverage 4° 8°
34°
27°

8. Additional procedures
Gastrocnemius recession
Exploration/debridement of posterior tibial tendon if symptomatic
Correction of hallux valgus with hypermobile 1st ray (Lapidus procedure)
Reference:
Zwipp H, Rammelt S. [Modified Evans osteotomy for the operative treatment of acquired pes planovalgus]. Oper Orthop Traumatol Jun;18(2):182–197.
Zwipp H et al. Oper Orthop Traumatol. 2006;18:182–197.
Hansen ST Jr. Functional Reconstruction of the Foot and Ankle; 2000.

9. Take-home messages
Lateral column lengthening results in 3-D correction of flatfoot (dorsolateral peritalar subluxation)
Add gastrocnemius recession generously
Add further procedures as required