Background: Calcaneal osteotomies are a common procedure in foot and ankle surgery for the treatment of the painful flexible Progressive Collapsing Foot Deformity (PCFD). The lateral calcaneal lengthening osteotomy (LCLOT) allows a three-dimensional foot and ankle flatfoot correction with a single osteotomy. The purpose of this article is to review the types of calcaneal lengthening osteotomies. Methods: Review of anatomical, biomechanical and clinical studies and reviews. Results: The LCLOT shall be differentiated from the Evans osteotomy or Z-shaped calcaneal lengthening osteotomy. The LCLOT is performed at the sinus tarsi and corrects at the subtalar joint axis biomechanically the pathological hindfoot valgus, foot abduction, and medial arch collapse. The LCLOT technique might vary regarding graft and fixation type. The LCLOT has good clinical results with high union rates. Conclusions: The LCLOT is a powerful and successful single-site osteotomy for the triplanar correction of the painful flexible flatfoot/PCFD.

Background: In the past few years, great importance has been given to coronal plane deformity and to pronation of the first metatarsal (M1) in hallux valgus. We believe that tensioning of the medial metatarsal-sesamoid ligament (MMSL) as a consequence of M1 medial displacement in relation to the sesamoids might be the main cause of M1 pronation. This study aimed to retrospectively evaluate if M1 pronation is corrected after an adequate M1 head reduction over the sesamoids, using the Minimally Invasive Chevron–Akin (MICA) technique. Material and Methods: We retrospectively reviewed a series of consecutive patients with symptomatic hallux valgus deformity, who underwent surgical treatment with the MICA technique between November 2021 and July 2022. Patients’ radiographic weight-bearing images were retrospectively evaluated for pre- and postoperative pronation and metatarsal-sesamoid relative positioning. M1 pronation was assessed and classified as described by Okuda et al. Pronation was considered to exist in types R and I, ie, every time there was not an angular shape of the M1 head. Satisfactory sesamoid reduction was considered when the lateral sesamoid was, at least, 50% covered by the metatarsal. Results: Ninety-one feet (67 patients) met the inclusion criteria. The mean age at the time of surgery was 57.9 years. Most patients underwent unilateral surgery [right foot, 24 (35.8%); left foot, 19 (28.4%)] with 24 patients (35.8%) undergoing bilateral surgery. Eighty-four feet (92.3%) had preoperative pronation. Among these, 54 feet (64.3%) had satisfactory positioning of the head over the sesamoids postoperatively and 30 feet (35.7%) did not. Of the 54 feet with satisfactory positioning, 51 (94.4%) did not show postoperative metatarsal pronation, while 3 (5.6%) did (P < .0001). Of the 30 feet with unsatisfactory reduction of the M1 head, 28 (93.3%) had postoperative pronation and 2 (6.7%) had no pronation (P < .0001). Conclusion: According to our study, first metatarsal pronation is predominantly self-corrected when a satisfactory reduction of the head of M1 over the sesamoids is achieved, using the MICA technique. We hypothesize that pronation might be due to MMSL tensioning however further basic science and clinical studies using weight-bearing computed tomography and biomechanical evaluation are needed to confirm our findings. Level of Evidence: Level IV

Background: Coronal talar translation is an important marker of deformity in ankle arthritis, and its correction is vital in total ankle replacement (TAR). The current method for measuring this deformity is talar center of migration (TCM). We developed a novel method, TCM-Ratio (TCM-R), to measure talar translation accurately across all talus sizes using noncalibrated radiographs. Furthermore, we aimed to describe correlations between TCM-R and concomitant procedures during TAR. Methods: Patients were collected from a single-institution prospective TAR registry from June 2023 to May 2024. Inclusion criteria were preoperative calibrated weight-bearing radiographs. For each patient, 4 raters measured the TCM (distance from center of talus to mechanical axis of tibia) and the TCM-R (talar displacement divided by talar radius). Intraclass correlation coefficients (ICCs) were used to assess inter-rater agreement. Pearson correlations were used to assess agreement between TCM-R and TCM. Results: Fifty-eight patients were included, 60.3% male, with mean age 64.8 ± 9.4 years, and mean BMI 30.0 ± 4.7. Inter-rater agreement was excellent for TCM (ICC = 0.914) and TCM-R (ICC = 0.944). TCM-R was highly correlated with TCM ( R = 0.95, CI 0.91-0.97, P < .001). The mean absolute value of TCM-R was 13.89% ± 11.29% (range, −34.57% to +47.53%). Conclusion: We described a new ratio-based method, TCM-R, to measure coronal talar translation, obviating the need for calibrated radiographs while accounting for variations in talar size. TCM-R had excellent inter-rater reliability and strongly correlated with TCM. Level of Evidence: Level IV, case series.

Combined angular deformities of the knee and foot are challenging clinical presentations for the orthopedic surgeon. We describe a surgical technique used in a 58-year-old man diagnosed with genu varum associated with progressive collapsing foot deformity and severe hallux valgus. The surgical team and the patient decided to perform a one-stage correction of all deformities. The procedure included corrective osteotomies with bone grafting and soft tissue reconstruction. The varus knee, hindfoot valgus, and hallux valgus were properly corrected intraoperatively with the surgical techniques described here. Satisfactory functional outcomes and excellent maintenance of the realignment were achieved at short-term follow-up. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Chronic tendon ruptures can be difficult to manage as end-to-end repair can be challenging. In this scenario, reconstruction techniques with tendon grafts may be useful. The ideal tendon graft would be one that has similar biomechanical properties, low donor-site morbidity and length compatible with the tendon gap. We describe a safe technique for the reconstruction of a chronic extensor hallucis longus tendon rupture using a plantaris tendon graft. Level of Evidence V, Therapeutic Studies; Expert Opinion.