Progressive Collapsing Foot Deformity 1AB: Comparison in Patients Treated with Medializing Calcaneal Osteotomy and Lateral Column Lengthening with and without Soft Tissue Reconstruction

Abstract

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Progressive collapsing foot deformity (PCFD) is a common condition affecting 20 to 30% of the population, especially women. Characterized by loss of the medial longitudinal arch, hindfoot valgus, and forefoot abduction, among other clinical signs. Initially, the pathogenesis was attributed to posterior tibial insufficiency. Myerson published a consensus in 2020 proposing the term PCFD, a complex three-dimensional deformity, shifting the focus away from the posterior tibial tendon (PTT). Surgical treatment of stage 1AB PCFD is debated due to the wide range of procedures to implement. Objectives: compare the clinical-radiological outcomes of two groups of patients diagnosed with stage 1AB PCFD. One group underwent Medializing Calcaneal Osteotomy (MCO), External Column Lengthening (ECL), and medial soft tissue intervention, while the other group underwent only MCO and ECL. Methods: Patients who underwent MCO and ECL with and without medial soft tissue intervention from January 2012 to December 2022 were retrospectively studied. Inclusion criteria: diagnosis of stage 1AB PCFD undergoing surgery (MCO, ECL, with and without medial soft tissue intervention), minimum postoperative follow-up (POF) of 12 months. The decision to perform medial soft tissue reconstructive procedures was at the discretion of the treating surgeon. Exclusion criteria: patients with previous surgical procedures for PCFD correction, patients with other bony surgical procedures on the medial column (Cotton, Bosch, Chevron, etc.), incomplete electronic medical records. Patients were evaluated preoperatively (preop) and at POF with weight-bearing anteroposterior and lateral radiographs of both feet and ankles. Measurement of calcaneal inclination angle, medial column height, talo-first metatarsal angle in the frontal and lateral views, talo-navicular coverage angle, and external column length was performed. Clinical assessment was conducted using the AOFAS score. Demographic data were collected. Results: Thirty-six patients were included, divided into two groups: Group 1: 13 patients operated with MCO and ECL. Group 2: 23 patients who underwent MCO, ECL, and medial soft tissue intervention. Long-term results were statistically significant in favor of Group 2 for POF measurements of calcaneal inclination angle, medial column height, and talo-first metatarsal angle in the frontal view. Measurements of external column length showed less long-term correction for Group 2. The AOFAS score demonstrated significant differences in both groups between preop and POF measurements. Conclusion: In stage 1AB PCFD, it is postulated that the surgical approach incorporating MCO with ECL along with medial soft tissue procedures may result in a more favorable radiological evolution in long-term follow-up compared to patients undergoing only bony procedures. However, the favorable clinical outcomes of both groups suggest that selected treatment could effectively address the patient's complaint and problem. It is postulated that by restoring foot biomechanics, stress on medial structures would be reduced, thus favoring their proper recovery and function. The possibility of conducting multicenter and biomechanical studies in the future to expand knowledge in this field is proposed.