The ultimate goals of all osteotomies are to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis. The heel bone can be realigned to achieve a different orientation, which can correct many different deformities and foot/ankle problems. For example, abnormally high or low arches can be addressed with a calcaneal osteotomy.
If your pain is worsening or you have a deformity of the foot and ankle that is not responding to other treatments, an osteotomy may be part of your surgical reconstruction plan.
Examples of osteotomy surgeries include:
- A calcaneal osteotomy is a controlled break of the heel bone to correct a deformity of the foot and ankle. The calcaneus, or heel bone, plays an important role in walking.
- A Chevron Osteotomy is a common surgery to treat a bunion. A bunion (also known as hallux valgus) is a misalignment of the knuckle of the big toe. This misalignment causes the big toe to turn toward the smaller toes. It often creates a bump at the base of the big toe. Bunions are not always painful, but this deformity generally will increase over time.
A single foot contains 26 bones, any of which can be linked to a source of discomfort. A bone injury can affect the shape, balance or function of the foot.
A bunion is a visible, bony bump that forms at the joint of the toe. It occurs when some of the bones in the front part of the foot move out of place.
Cavus foot is a condition in which the foot has a very high arch. This can lead to a variety of other symptoms and can develop at any age.
Clubfoot is an abnormal inward curving of the foot.
Adult flatfoot is caused by changes in the tendon, impairing its ability to support the arch, thus resulting in the flattening of the foot.
Heel Bone Fractures
The heel bone is often compared to a hard-boiled egg due to its thin, hard covering on the outside and its soft, spongy bone on the inside. Once the outer shell is broken, the bone tends to collapse and become fragmented.
Progressive Flatfoot (Posterior Tibial Tendon Dysfunction)
If this tendon becomes inflamed, overstretched, or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot.
In a osteotomy, an incision is made to the foot. After the bone is cut, it is moved to the desired location and fixed in place. Most often, surgical implants such as screws hold the bones together and support healing.
The most common types include:
- Evans osteotomy: If you look down at your foot, you can see an inside edge and outside edge of the foot. For the foot to be straight, the inside edge of the foot and outside edge of the foot must be similar lengths. An Evans osteotomy is a controlled break that makes the outside part of the foot longer to help make the foot straight. Often a bone graft is used. The procedure may be performed on patients with flatfoot deformity.
- Dwyer osteotomy: This is a break that removes an outside-based wedge of bone from the calcaneus in order to realign the foot. It is sometimes performed on patients with abnormally high arches.
- Medializing osteotomy: In this procedure, the heel bone is cut and moved towards the inside part of the foot to help restore a fallen arch. Arthritis, loss of tendon function, and injury are some causes of a fallen arch.
- Lateralizing osteotomy: This is another osteotomy for abnormally high arches. In this procedure, the heel bone is cut and shifted to the outside to reduce the arch and improve alignment.
- Calcaneal Osteotomy: This is commonly is combined with other procedures to reconstruct the foot. This type of surgery usually is an outpatient procedure, meaning you can go home the same day as surgery, but will vary depending on each patient and surgeon.
- Chevron Osteotomy: During this surgery, the foot and ankle orthopaedic surgeon cuts the end of the long bone leading to the big toe (metatarsal) and rotates the end of the bone to straighten the big toe. The painful bump at the base of the big toe is filed down. This generally relieves the pain associated with a bunion and gives the foot a more normal appearance. In some cases, the orthopedic surgeon may use removable wires or permanent screws to hold the end of the bone in its new place. An additional procedure to tighten the soft tissue on the inside of the toe may be performed in conjunction with the osteotomy.
A dressing will be applied by your surgeon in the operating room, and you will be given a special shoe or boot. Depending on your surgeon’s preference, the splint may be changed to a cast in 1-2 weeks. You will have to keep weight off your foot for 4-6 weeks. At that point, progressive weight bearing usually can start. Getting back to regular activities typically takes 3-6 months and swelling will improve slowly. If you have another foot or ankle procedure done at the same time, your recovery may be longer.