The role of correcting osteotomy of Calcaneus with bioglassceramic implant in foot deformation treatment on the background of neurological diseases

Abstract

Flat feet is a common pathology, which aggravates the course of several neurological diseases, including cerebral palsy and Spina bifida; at the same time, it is a result of a prolonged imbalance of muscles. Aim. To show the results of surgical treatment of neurological flat feet with elongation of the the heel bone using Bio-ceramic implant bone substitute in our observation. Material and Methods. The observation covers a group of 12 patients (20 feet), treated surgically for neurologic symptomatic flatfoot in the period of 2015 - 2019 at the clinical base of the Department of General Surgery of the FEU "UzhNU" with a minimum observation period of 1 year. Of the total number of patients, 8 (66.6%) were diagnosed with cerebral palsy, 1 (8.4%) had a condition associated with neurofibromatosis, and 3 (25%) were diagnosed with Spina bifida. Gender distribution indicated predominance of male representatives - 7 (58.3%) patientsversus 5 (41.7%) female patients. The average age was 21.7 years, with a range of 18 to 32 years. Results and Discussion. Treatment outcomes at 6 months were assessed according to the Foot and Ankle Outcome Score (FAOS) as excellent in 9 patients, and good in 2 patients. In 12 months, excellent results were obtained in 7 patients, and good results were obtained in 2 patients. There were no unsatisfactory results in our observation. The average values of the angles were as follows: heel-to-elbow angle before surgery equaled 27.03°; after surgery within 6 months - 22.14°; after surgery within 12 months - 21.87°. Supraorbital-1metatarsal angle before surgery equaled 28.02°; after surgery within 6 months - 14.11°; after surgery within 12 months- 15.04°. The angle of the heel bowel before surgery equaled 12,97°; after surgery within 6 months - 20,69°; after surgery within 12 months - 20.04°. There was a statistically significant difference in the magnitude of angles in pre- and post-operative measurements, and a statistically insignificant difference in the magnitude of angles in terms of 6 and 12 months of postoperative period, which is close to the normal values of correction (all p-values up to α=0.05 are insignificant). Radiographic consolidation of the osteotomic bone wound marked as disappearance of the fracture line between the graft and bone tissue was achieved in all cases postoperatively after 8-10 weeks. There were 2 cases of complications that did not significantly affect the final clinical and functional outcomes. Conclusions. According to the literature data and the data obtained in our observation, the method of elongation of the calcaneus with the use of osteoplasty from a biosocial implant can be used as a method of choice in the treatment of neurological symptomatic flatness. The positive results obtained in the correction of angular deformities and the maintenance of a stable form close to the normal values of the calcaneus in relation to the skeleton of the foot indicate the feasibility of using this method in clinical practice.

Keywords

• calcaneus, osteoplasty, bioceramic implant