My calcaneal osteotomy recovery story

Living with flat feet for five decades might seem manageable until the supporting structures begin to fail. What started as a genetic condition that allowed normal sporting activities gradually transformed into a debilitating issue requiring surgical intervention. The decision to undergo a calcaneal osteotomy represents a pivotal moment for many patients facing progressive flatfoot deformity, particularly when conservative treatments no longer provide adequate relief. This surgical procedure, designed to realign the heel bone and restore proper foot mechanics, offers hope for returning to pain-free activities like running and competitive sports.

The journey from diagnosis to recovery involves multiple phases, each presenting unique challenges and milestones. Understanding the complexity of this procedure and its outcomes becomes crucial for patients weighing their treatment options. Recovery stories provide invaluable insights into the reality of post-operative healing, helping others make informed decisions about their own treatment paths.

Pre-operative assessment and dwyer calcaneal osteotomy indication

The decision to proceed with calcaneal osteotomy surgery rarely comes lightly, particularly when symptoms remain relatively manageable. Many patients find themselves in a similar position – experiencing mild to moderate discomfort that doesn’t significantly impact daily activities, yet facing the prospect of progressive deterioration without surgical intervention. The pre-operative assessment phase becomes critical in determining whether surgical correction will provide meaningful improvement over conservative management.

Clinical evaluation typically reveals a constellation of findings that collectively support the surgical indication. Patients often report ankle swelling following sports activities, requiring several days of rest between sessions. This pattern suggests that the foot’s compensatory mechanisms are becoming overwhelmed, leading to inflammatory responses that indicate structural inadequacy rather than simple overuse.

Hindfoot valgus deformity diagnosis using saltzman view radiographs

Radiographic assessment forms the cornerstone of pre-operative planning for calcaneal osteotomy procedures. The Saltzman view, specifically designed to evaluate hindfoot alignment, provides crucial information about the degree of valgus deformity present. This specialised radiographic projection allows surgeons to quantify the extent of heel bone malalignment and plan the appropriate degree of correction needed during surgery.

Standard anteroposterior and lateral foot radiographs, while useful for assessing overall foot structure, often fail to capture the three-dimensional nature of hindfoot deformity. The Saltzman view addresses this limitation by providing a more accurate representation of heel alignment in the coronal plane, enabling precise measurement of the hindfoot valgus angle that guides surgical decision-making.

Lateral talocalcaneal angle measurement and correction planning

The lateral talocalcaneal angle serves as a key radiographic parameter in assessing flatfoot deformity severity. Normal values typically range between 25 and 40 degrees, with angles exceeding this range indicating progressive collapse of the longitudinal arch. This measurement helps determine not only the need for surgical correction but also the extent of osteotomy required to restore normal foot mechanics.

Correction planning involves calculating the desired degree of heel displacement to achieve optimal foot alignment. Surgeons must balance adequate correction with realistic expectations, considering factors such as soft tissue flexibility, adjacent joint mobility, and the patient’s functional demands. Overcorrection can lead to lateral foot overload , while undercorrection may result in persistent symptoms and continued deformity progression.

Single assessment numeric evaluation (SANE) score baseline documentation

Patient-reported outcome measures provide essential baseline data for evaluating surgical success. The SANE score represents a simple yet effective tool for documenting pre-operative functional status and tracking post-operative improvement. This single-question assessment asks patients to rate their foot function as a percentage of normal, providing a straightforward metric for comparing outcomes.

Establishing baseline SANE scores becomes particularly valuable when patients present with relatively mild symptoms. Many individuals considering calcaneal osteotomy report scores in the 60-80% range, reflecting their ability to maintain most activities despite experiencing some limitations. This baseline documentation helps set realistic expectations for post-operative improvement and provides objective data for outcome assessment.

Posterior tibial tendon dysfunction classification and associated pathology

Advanced imaging studies often reveal associated pathology that influences both surgical planning and expected outcomes. Posterior tibial tendon dysfunction frequently accompanies progressive flatfoot deformity , creating a complex interplay between structural malalignment and tendon insufficiency. MRI findings typically demonstrate tendinosis, tenosynovitis, or partial tearing of this crucial stabilising structure.

The classification of posterior tibial tendon dysfunction helps guide treatment decisions and prognosis. Stage I dysfunction involves tendon inflammation without deformity, stage II includes flexible flatfoot deformity, and stage III encompasses rigid deformity with potential hindfoot arthritis. Understanding the patient’s classification assists in determining whether isolated calcaneal osteotomy will suffice or whether additional procedures may be necessary.

Surgical technique and medialising calcaneal displacement osteotomy procedure

The surgical approach to calcaneal osteotomy demands meticulous attention to anatomical detail and precise execution of each procedural step. Success depends heavily on proper patient positioning, careful soft tissue handling, and accurate bone cuts that achieve the desired correction while maintaining structural integrity. The procedure typically requires regional or general anaesthesia and may be performed on an outpatient basis, depending on patient factors and surgeon preference.

Pre-operative planning extends beyond radiographic measurements to include consideration of skin condition, soft tissue envelope, and patient-specific anatomical variations. Surgeons must account for the three-dimensional nature of the deformity when planning their approach, as correction in one plane may influence alignment in others. The goal remains achieving balanced correction that addresses the primary pathology while minimising secondary complications.

Lateral approach through sural nerve protection protocol

The lateral surgical approach provides optimal access to the calcaneus while minimising disruption of medial soft tissue structures. Careful identification and protection of the sural nerve becomes paramount during this approach, as inadvertent injury can result in permanent sensory deficits along the lateral foot border. The nerve’s variable anatomy requires vigilant dissection and gentle retraction throughout the procedure.

Incision placement follows the posterior border of the fibula, extending distally along the lateral calcaneal wall. This approach allows excellent visualisation of the osteotomy site while maintaining adequate soft tissue coverage for wound healing. Proper haemostasis throughout the dissection prevents post-operative haematoma formation that could compromise healing or increase infection risk.

Chevron osteotomy cut execution and bone fragment mobilisation

The chevron-shaped osteotomy cut represents the technical cornerstone of the procedure, requiring precision to achieve appropriate correction while maintaining bone stability. The osteotomy typically begins approximately 1-2 centimetres posterior to the calcaneocuboid joint, angling posteriorly and plantarward to create the characteristic V-shaped configuration. This design maximises bone contact area and inherent stability following displacement.

Bone fragment mobilisation requires gentle manipulation to avoid fracture propagation or soft tissue injury. The plantar fragment, containing the heel’s weight-bearing surface, must be carefully shifted medially to reduce hindfoot valgus. The degree of medial displacement directly correlates with the amount of correction achieved , making precise measurement crucial for optimal outcomes.

Steinmann pin fixation and cortical screw placement technique

Temporary fixation using Steinmann pins allows assessment of correction and fragment positioning before definitive screw placement. These pins serve as handles for fragment manipulation and provide provisional stability during fluoroscopic evaluation. Pin placement must avoid neurovascular structures while providing adequate purchase in both bone fragments.

Definitive fixation typically employs large-diameter cortical screws that compress the osteotomy site and provide rigid internal fixation. Screw trajectory follows the long axis of the calcaneus, engaging both cortices for maximum stability. Proper screw placement prevents loss of reduction during the healing phase while allowing early mobilisation in a protective boot.

Intraoperative fluoroscopic imaging and heel alignment verification

Fluoroscopic imaging provides real-time feedback during the procedure, enabling surgeons to verify adequate correction and proper hardware placement. Multiple projections, including anteroposterior, lateral, and axial calcaneal views, confirm appropriate fragment positioning and screw trajectory. This imaging modality proves invaluable for detecting potential complications before wound closure.

Heel alignment verification involves assessing both clinical appearance and radiographic parameters. The heel should appear centred beneath the leg when viewed from behind, with restoration of normal hindfoot alignment angles on radiographic evaluation. Achieving optimal correction at surgery significantly influences long-term functional outcomes , making intraoperative verification essential for success.

Post-operative immobilisation protocol and non-weight bearing phase

The immediate post-operative period requires strict adherence to weight-bearing restrictions to protect the healing osteotomy site. Most protocols mandate complete non-weight bearing for 6-8 weeks, during which patients rely on crutches, knee scooters, or wheelchairs for mobility. This phase presents significant challenges for active individuals accustomed to unrestricted movement, requiring careful planning for daily activities and work responsibilities.

Immobilisation typically begins with a well-padded splint or cast that maintains the foot in neutral position while accommodating post-operative swelling. Pain management during this phase often requires multimodal approaches, including oral analgesics, ice therapy, and elevation. Patients frequently report pain levels of 1-2 at rest, escalating to 3-5 during position changes or inadvertent weight-bearing attempts.

The psychological impact of prolonged immobilisation should not be underestimated. Many patients experience frustration with their temporary disability, particularly those maintaining active lifestyles before surgery. Setting realistic expectations about the recovery timeline helps patients cope with the temporary restrictions while focusing on long-term benefits. Support systems become crucial during this vulnerable period, as patients often require assistance with basic activities of daily living.

Progressive weight bearing transition using CAM walker boot

The transition from non-weight bearing to full weight bearing represents a critical milestone in the recovery process. This phase typically begins 6-8 weeks post-operatively, following radiographic confirmation of adequate bone healing. The CAM walker boot provides essential protection during this vulnerable period, offering controlled support while allowing gradual loading of the healing osteotomy.

Initial weight bearing often produces anxiety and discomfort as patients relearn normal walking patterns. The boot’s rocker sole facilitates forward progression but can create challenges on uneven surfaces or stairs. Many patients report feeling unstable initially, requiring gradual confidence building through progressive activity advancement. Patience during this phase proves essential , as rushing the process can lead to setbacks or complications.

The ability to abandon crutches marks a significant psychological victory for most patients. Regaining the freedom to carry a handbag instead of a backpack and feeling “more normal” provides powerful motivation for continued progress. However, the boot’s bulk and weight often limit certain activities, requiring ongoing adaptations and realistic expectation management.

Stairs continue to present challenges even after achieving independent mobility, as the boot’s design creates balance difficulties when navigating steps.

Physiotherapy rehabilitation and achilles tendon stretching programme

Formal physiotherapy typically begins once patients achieve protected weight bearing in the CAM boot. Initial sessions focus on gentle range of motion exercises, swelling management, and gait training. The prolonged immobilisation period often results in significant stiffness and muscle weakness that require systematic addressing through progressive rehabilitation protocols.

Achilles tendon stretching assumes particular importance following calcaneal osteotomy, as the heel bone repositioning can alter tendon mechanics and increase perceived tightness. Gentle stretching exercises help restore normal ankle dorsiflexion range while preventing adaptive shortening that could limit functional recovery. These exercises must be performed carefully to avoid excessive stress on the healing osteotomy site.

Progressive strengthening exercises target the intrinsic foot muscles, posterior tibial tendon, and peroneal tendons that provide dynamic foot support. Restoring muscle balance becomes crucial for long-term success , as these structures must compensate for any residual mechanical alterations following surgery. The rehabilitation programme typically spans several months, with exercise complexity increasing as healing progresses.

Balance and proprioception training addresses the sensory deficits that commonly develop following prolonged immobilisation. These exercises help retrain the nervous system’s ability to maintain stability and control during dynamic activities. Successful completion of this rehabilitation phase often determines whether patients can return to high-level activities like running or competitive sports.

Long-term functional outcomes and american orthopaedic foot ankle society score assessment

Long-term success following calcaneal osteotomy extends beyond simple pain relief to encompass functional restoration and activity resumption. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score provides a standardised assessment tool that evaluates pain, function, and alignment domains. This scoring system helps quantify outcomes and compare results across different patients and surgical techniques.

Patients often question whether they will achieve complete pain freedom and return to pre-symptom activity levels. Realistic expectations suggest that most patients experience significant symptom improvement , though complete pain elimination may not be universal. The ability to perform 5-kilometre runs or play competitive tennis without subsequent swelling represents an excellent outcome that many patients achieve with appropriate rehabilitation.

The healing process requires patience, as bone remodelling and soft tissue adaptation continue for 12-18 months post-operatively. Early outcome studies may not reflect the ultimate functional potential, emphasising the importance of long-term follow-up data. Patients who achieve excellent outcomes often report minimal pain at rest and only mild discomfort during strenuous activities.

Success might be defined as the ability to perform desired activities without significant pain or swelling, rather than achieving perfect symptom resolution.

Factors influencing long-term outcomes include pre-operative deformity severity, patient age, activity level, and compliance with rehabilitation protocols. Younger patients with flexible deformities and strong motivation for activity return typically achieve better functional outcomes. However, even older patients with more advanced pathology can experience meaningful symptom relief and activity improvement.

The decision to undergo calcaneal osteotomy ultimately depends on individual risk-benefit assessment. For patients experiencing progressive symptoms that limit desired activities, surgery offers the potential for significant improvement. Those with minimal symptoms may benefit from continued conservative management while monitoring for deformity progression. Regular follow-up with experienced foot and ankle specialists helps guide these complex decisions and optimise long-term outcomes for each patient’s unique situation.