Records of 25 patients with HS who underwent ZO from January 2016 to June 2018 at the Department of Foot and Ankle Surgery, Honghui Hospital, Xi’an Jiaotong University (Xi’an, China) were reviewed. Informed consent was obtained from all study subjects. All procedures were performed by 1 foot and ankle orthopaedic surgeon. A minimum follow-up of 1 year after surgery was required for all patients. Inclusion criteria were patients
Specific inclusion and exclusion criteria were determined for selected patients. Inclusion criteria were patients over 18 years of age, at least 6 months of documented failed conservative treatment, and no prior foot and ankle surgery. Exclusion criteria were patients of HS with AT rupture, diabetes mellitus with or without neuropathic joint destruction, and local infection. Four patients were excluded according to the criteria, and another 2 patients were lost to follow-up. Therefore, 19 cases (19 feet) were included in the current study. The average age at the time of the operation was 48.6 ± 7.3 (range, 31–71) years. The mean follow-up time was 16.3 ± 4.2(range, 13–37) months. Data regarding age, gender, operative side, body mass index (BMI), smoking, and follow-up duration were collected.
Patients was placed in the lateral position on the operating table. All patients received spinal or epidural anesthesia. A thigh tourniquet with 280 mmHg pressure was applied. Surgical procedures were performed using a full-thickness lateral approach (Fig. 1A). Through a lateral skin incision, the calcaneus was exposed. And then, through the design of pre-operation, closing wedge osteotomy was performed (Fig. 1B). According to the preoperative lateral radiograph of the calcaneus, the design of pre-operation taking into account the angle, width of the wedge, and orientation. When the osteotomy was completed with a shorter blade, the calcaneus was fixed with full threaded cannulated screws under the guidance of 2 K-wires (Fig. 1C). When fixation was finished, using a C-arm device to reconfirm the position of the screws. Then, using a 2 − 0 absorbable suture to repair subcutaneous tissue, and using a 3 − 0 nonabsorbable suture to close the skin.
All patients were not allowed to walk for two weeks. All patients were allowed to perform passive motions of the ankle. Skin sutures were removed 2 weeks after surgery. At 8 weeks postoperatively, partial weight bearing was allowed in the removable walker boot. Patients were allowed full weight bearing at 3 months postoperatively.
Clinical And Radiographic Evaluations
Functional evaluations, pain assessments, evaluation of ankle joint, and anatomy changes were collected. Results of the functional evaluations, pain assessments and evaluation of ankle joint performed preoperatively and postoperatively (last follow up visit) were included to determine the Foot Ankle Society ankle-hindfoot scale (AOFAS), Visual Analogue Scale (VAS), and ankle range of motion (AROM). Results of anatomy changes included changes in the Chauveaux-Liet (CL) angle(Fig. 2).
All data were analyzed statistically using SPSS (version 22.0; IBM, Chicago, IL). Paired t-tests were used to compare the outcomes measures (AOFAS, VAS, ROM and CL angle) recorded before surgery and at last follow-up visit. All values assessed were expressed as the mean ± standard deviation (SD). Statistical significance was defined at P༜0.05.