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Calcaneus Osteotomy (lateralizing) 28300

 
CPT Coding Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:Dwyer osteotomy, Chambers osteotomy, calcaneal osteotomy, calcaneus osteotomy lateralizing calcaneal osteotomy

 

Lateralizing Calcaneus Osteotomy CP

Lateralizing Calcaneus Osteotomy Indications

  • Residual hindfoot varus

 Lateralizing Calcaneus Osteotomy Contraindications

  •  Anterior ankle impingement

Lateralizing Calcaneus Osteotomy Alternatives

  • Conservative Treatment

Lateralizing Calcaneus Osteotomy Pre-op Planning

  • Consider concomittant dorsiflexion osteotomy of the first ray or dorsiflexion fusion of the first TMT joint if the first ray is plantarflexed (common in CMT disease)
  • Consider excising posterior or medial subtalar joint osteophytes commonly seen in patients with cavovarus foot.

Lateralizing Calcaneus Osteotomy Technique

  • Posterior lateral incision.
  • Dissection to the calcaneus.
  • Transverse calcaneal osteotomy.  Ensure medial aspect of cut is not near the sustentaculum tali (NV bundle).
  • Mobilize the tuberostiy fragment and Achilles.
  • Translate tuberosity fragment laterally.
  • Place two cannulated screws using standard AO technique perpendicular to the plane of the osteomy.
  • Trim lateral aspect of tuberosity fragment and use as bone graft.
  • C-arm views (lateral ankle and Broden views) taken to ensure screws do not penetrate the subtalar joint.
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Lateralizing Calcaneus Osteotomy Complications

Lateralizing Calcaneus Osteotomy Follow-up care

  • Post-op:Bulky posterior splint, NWB
  • 7-10 Days: Wound check, Place in walker boot, or short leg cast;  NWB.  Begin gentle ankle ROM exercises if any concomittant peroneal tendon procedures have been performed
  • 6-8 Weeks: WBAT in walker boot provided union is evident on xray. Begin physical therapy.
  • 3 Months: begin sport specific physical therapy /  training
  • 4-6 Months: return to full competition/sport with ankles taped or in athletic ankle brace.
  • 1Yr:Follow up eval, Ankle/Foot outcomes testing.  

Lateralizing Calcaneus Osteotomy Outcomes

  • -

Lateralizing Calcaneus Osteotomy Review References

  • Younger AS, JAAOS 2005;13;302