Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study.PURPOSE
 Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction.  The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications.


 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL.  Strayer procedure, spring ligament plication, and FDL transfer were done in all patients.  Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire.  Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported.


 At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups.  Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months.  However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively.  11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL.  Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion.


 CONCLUSION
 LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
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