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      Plantar Approach for Midfoot Wedge Resection to Reconstruct the Rocker Bottom Foot.

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          Abstract

          Chronic deformity of the foot can lead to ulceration, infection, and amputation. Midfoot wedge osteotomy for deformity correction has been described in the literature; however, most reports are case review or small series. Wedge osteotomy can be performed from a medial or plantar approach, but there are limited data on outcomes regarding these relatively uncommon procedures. This study aims to review a population of patients with a rocker bottom foot deformity that underwent a midfoot wedge resection performed from the plantar surface for deformity correction, wound healing, and limb salvage. A review of medical records from a single foot and ankle surgeon was undertaken. Patients who had a midfoot wedge performed from the plantar surface to address rocker bottom deformity resulting from Charcot neuroarthropathy or severe flatfoot were included. Thirty patients met inclusion criteria. The outcome measures evaluated were minor and major complications, wound healing, and functional limb status. Statistical analysis was performed to evaluate factors that influenced outcomes. At time of final follow up, 17 of 20 (85%) preoperative wounds had healed. Mean preoperative talo-first metatarsal angle was -25° and improved to -5° postoperatively. An 87% limb salvage rate (26/30) was demonstrated. Body mass index was the only statistically significant factor that influenced functional limb status. Maintaining a functional limb can have profound effects on a patient's quality of life. Generally, patients with this severe rocker bottom foot deformity have multiple comorbidities and are at an increased risk of major amputation and early death. The current study has shown that patients with a rocker bottom foot deformity can benefit from midfoot wedge resection from a plantar approach to achieve a plantigrade foot.

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          Author and article information

          Journal
          J Foot Ankle Surg
          The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
          Elsevier BV
          1542-2224
          1067-2516
          Sep 2019
          : 58
          : 5
          Affiliations
          [1 ] Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: jpersky@hotmail.com.
          [2 ] Fellow, Orthopedic Foot and Ankle Center, Westerville, OH.
          [3 ] Biostatistician, Clinical Outcomes Research, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
          [4 ] Assistant Professor, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Director, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA; Chief, Podiatry Section, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA.
          Article
          S1067-2516(19)30007-9
          10.1053/j.jfas.2019.01.004
          31474393
          2ad75a8a-ad2f-445d-8d80-188036481702
          History

          limb salvage,external fixation,Charcot neuroarthropathy,rocker bottom deformity,midfoot wedge

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