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Old 02-23-2012, 12:24 PM   #1
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Calcaneal osteotomies - so many different types !

Hi everyone,
This board is wonderful . Thank you all for providing so much information. I have a question regarding two different procedures recommended by two different doctors:

Doctor #1 - Mercy Hospital
Medial sliding calcaneal osteotomy

Doctor #2 -HSS

Posterial calcaneal osteotomy
Anterior calcaneal osteotomy
Medial cuneiform osteotomy

Are they the same ?If not, what are the differences?

Thanks !

 
Old 02-24-2012, 11:38 PM   #2
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Re: Calcaneal osteotomies - so many different types !

Hi,

There is actually quite a difference between the two recommendations; the second recommendation includes the first and a whole lot more.

Doctor #1 -
Medial sliding calcaneal osteotomy -
This is a basic heel bone osteotomy. They cut the back of the heel bone, slide the cut part medially (toward the center of the body), and attach it.



Doctor #2 -
Anterior calcaneal osteotomy (aka Evans osteotomy/lateral column lengthening) & Posterior calcaneal osteotomy -
This is a double calcaneal osteotomy.
There is the initial cut of the back of the heel, sliding it medially, followed by cutting the front of the heel bone and inserting a wedge (often from the hip).


Medial cuneiform osteotomy -
This is also known as a Cotton osteotomy.
It involves cutting the medial cuneiform (on the inside of your foot, there's your big toe, then a long bone (1st metatarsal), right after this is the medial cuneiform) and inserting a wedge (often from the hip).



That however is my non-doctor, just someone who does a lot of reading (and thus could be wrong!), answer..

Last edited by lola456; 02-25-2012 at 01:03 AM.

 
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Old 02-25-2012, 05:03 AM   #3
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Re: Calcaneal osteotomies - so many different types !

Lola 456,
Thank you so much . You explain the difference very well. We went to 5 orthopedic surgeon and one podiatrist andthey all have a different recommendation. It all started when my 13 years old boy complained about foot pain . We went to the podiatrist. He recommended to take out the accessory navicular bone. Then we went to 5 orthopedict surgeon. Three recommended to take out the accesory navicular and two experts in flat foot reconstruction also recommended to fix the flat foot . As you see these two experts in flat foot reconstruction also have different opinions.
Dr #1 recommended Medial calcaneal osteotomy + fusion of the accessory navicular to the navicular + gastro recession.
Dr#2 recommended not to touch the accessory navicular just to fix the flat foot deformity with the double osteotomy + gastro recession + possible cottom osteotomy

All of that is not simple. I wish they could talk to each other . I feel like this is cooking a cake, everyone has its own recipe !
Thank you very much for your help . I will continue reading , a lot of information and help on this message board .

 
Old 02-25-2012, 05:38 AM   #4
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Re: Calcaneal osteotomies - so many different types !

I had the cotton osteotomy at HSS. They lower the bone for the big toe slightly. They did not use a wedge from my hip. Once the toe was repositioned, a pin was inserted. I had my ptt/spring ligament repaired, tendon transfer, cotton/calcaneal osteotomy and gastroc recession 19 months ago and doing well. Two years before having the surgery at HSS, a podiatrist did a modified kinder(accessory navicular) and repaired the PTT. Unfortunately, this did not really help in my case. Three different doctors said that for me the modified kinder failed because it did not address the underlying problem.

My doctor at HSS told me that he woul definitely repair the tendons, do the calcaneal osteotomy, tendon transfer and gastroc recession. He said that he wouldn't know if the cotton osteotomy and lateral column work would be needed until he actually got in there.

Flat foot surgery is not a set protocol. There are different combinations of surgery that comprise flat foot reconstruction depending on the individuals foot

 
Old 02-25-2012, 06:15 AM   #5
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Re: Calcaneal osteotomies - so many different types !

Hi Roxygirl, it is great to know . That's exactly what these two experts said . They both said that the modified Kinder prodedure proposed by the podiatrist will not address the underlying problem of flat foot deformity. The flat foot deformity needs to be addressed first . I am not a doctor so I don't really know which procedure is the best for treating flat foot deformity: it seems like Dr #1 procedure is more conservative while Dr # 2 is more aggressive in treating the flat foot deformity. I feel confortable with both doctors but would rather go with a more conservative approach . As it is, this flat foot reconstruction is very scary.
HSS doctor spent a lot of time with us explaining the flat foot deformity and it was worth the 5 hours trip back and forth in New York. I just don't know how manageable it is to have the surgery over there considering there are follow ups visits etc.. On another note , I was wondering what age you were when you first started with the modified kinder then the flat foot reconstruction? On this board it is a lot of adults experience, I would like to know more about teenager and kids . Maybe they recover quicker ? It is worth doing it while they are young as they heal faster ? Sometimes I would rather him decide when he is an adult instead of me making the decision for him . My daughter who is 9 years old was also recommended for the arthroerieis procedure ( i think that is the MBA implant). I will wait and take care of kid # 1 first . My hands are going to be full the next couple of months I can not thank you enough for all the help you provided me the past few months .

 
Old 02-25-2012, 06:32 AM   #6
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Re: Calcaneal osteotomies - so many different types !

I was about 50. I understand the drive being an issue. I was in the hospital for three nights. The next post op was when the splint was removed and hard cast put on. I think that the splint was removed at 10-14 days post op. The cast was on for about 8 weeks. You could ask the doctor how many post op appointments would be needed. Would it be possible to turn the appointment into a mini "vacation" by staying overnight and finding something (non walking) to do in the area. If the hotel prices in NY are too high, you may find better prices outside of the city. It is a hard decision. I could tell you that my experience at HSS was positive. The doctor was very responsive. If I called, I got a response quickly. The stay in the hospital was fine. The nursing staff was excellent and pain management good. I had a three hour round trip drive. Of course I am closer than you but the drive was well worth it for me. There are threads dealing with both hospitals you are considering. It may be worthwhile reading some of the threads. Good luck with your decision.

 
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Old 02-25-2012, 06:34 PM   #7
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Re: Calcaneal osteotomies - so many different types !

RoxyGirl made a good point - I made an assumption that the cuneiform osteotomy in question was a Cotton (with wedge), but perhaps it is just a sliding osteotomy..Either way, there is indeed quite a difference between all of the recommendations you were given!

I don't envy your situation..it's hard enough making such decisions for oneself, let alone for their child..

I could argue both sides of doing it as an adult vs as a child as well as which procedure to do - so I'll keep my mouth shut but to say a sincere good luck...Perhaps if you talked to doctor#1 again and told them what #2 proposed, they could share why they think their method is preferred?? It might not help at all, but it might make the answer a bit clearer..

---
Update:
If you're wanting to Google/read more about what they're talking about, I do believe the osteotomy combo is often referred to as the All American procedure or the Manoli-Pomeroy procedure.

Last edited by lola456; 02-25-2012 at 07:38 PM.

 
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Old 02-27-2012, 10:53 AM   #8
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Re: Calcaneal osteotomies - so many different types !

Roxygirl, thanks for all the good advice. I also wondered if the medial sliding calcaneal osteotomy could be suffisient to stop the flat foot deformity and thefore he will have a less agressive procedure ? I sent out an email to HSS as Lola 456 suggested to find out why the double osteotomy was the preferred approach and not the medial sliding osteotomy .I will let you know if I hear anything.

 
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