Surgeon details calcaneal osteotomy in patients with Charcot-Marie-Tooth disease
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A foot and ankle surgeon at Cedars Sinai Medical Center presented his technique for surgical intervention of Charcot-Marie-Tooth disease at the American Orthopaedic Foot & Ankle Society Annual Meeting. The meeting was held virtually.
According to Max P. Michalski, MD, MSc, the need for calcaneal osteotomy for the correction of hindfoot varus in patients with Charcot-Marie-Tooth (CMT) disease should be determined intraoperatively and after medial release.
“I think it is safe to say that we’ve all been frustrated by CMT and the ability to correct the heel position,” Michalski said in the presentation. “Fundamentals of management of the hindfoot varus in patients [with CMT] are understanding of the 3-dimensionial anatomy and deformity,” he said.
“The most basic understanding is that the tuberosity is now positioned medially. There is more to it than that. Hindfoot varus is a multiplanar deformity in the coronal and axial planes,” Michalski added.
In a previous study, Michalski and colleagues found rotation of the calcaneal tuberosity in the coronal plane provided the greatest level of correction.
“Similar to the coronal rotation obtained with a Z-closing wedge osteotomy, tuberosity rotation can obtain a similar correction,” he said.
He also stressed the importance of addressing each patient individually, especially when it comes to forefoot- vs. hindfoot-driven deformities.
Michalski concluded his presentation by offering keys to “free” the heel – allowing for the mobility necessary for rotation.
“First, make your lateral translation osteotomy cut. Insert your laminar spreader and then just walk away –either move to the next step [or] start closing one of the other steps of the procedure. This allows for soft tissue relaxation,” Michalski said.
“Second, make the posterior cut your Dwyer osteotomy. This can be done with a laminar spreader, which allows visualization of the cut and stabilizes your posterior tuberosity. Removing either a wedge or even a trapezoid in a severe deformity decompresses the tension of the tuberosity,” he added.
“Third, as we’ve talked before, plantar fascia release can be key, and this can be done through your incision at the base of your laminar spreader in the osteotomy. And last, tendo-Achilles lengthening can be done. It removes the deforming force.”
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Michalski MP, et al. Calcaneal osteotomy: ‘2D, or not 2D? That is the question’. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 10-12, 2020 (virtual meeting).
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