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Sensitivity of Plantar Pressure and Talonavicular Alignment to Lateral Column Lengthening in Flatfoot Reconstruction
Irvin Oh, MD1; Carl Imhauser, PhD2; Daniel Choi, MS2; Benjamin Williams, BS2; Scott Ellis, MD2; Jonathan Deland, MD2
1 Department of Orthopaedic Surgery and Rehabilitation, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Box 665, Rochester, NY 14620
2 Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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Investigation performed at the Hospital for Special Surgery, New York, NY

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jun 19;95(12):1094-1100. doi: 10.2106/JBJS.K.01032
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Lateral column lengthening (LCL) of the calcaneus is commonly performed as part of correction of the adult acquired flatfoot deformity. Increases in postoperative lateral plantar pressure associated with pain in the lateral aspect of the foot have been reported. The aim of this study was to investigate changes in pressures in the lateral aspect of the forefoot with increments of 6, 8, and 10 mm of LCL in a cadaveric flatfoot model. The hypothesis was that increasing the LCL incrementally by 2 mm will linearly increase the plantar pressures in the lateral aspect of the forefoot.


Eight fresh-frozen cadaveric foot specimens were used. A robot compressively loaded the foot to 400 N with a 310-N tensile load applied to the Achilles tendon. A flatfoot model was created by resecting the medial and inferior soft tissues of the midfoot, followed by axial load of 800 N for 100 cycles. Kinematic and plantar pressure data were gathered after the different amounts of LCL (6, 8, and 10 mm) were achieved.


The talonavicular joint demonstrated a median abduction angle of 4.4° in the axial plane and −2.6° in the sagittal plane in the flatfoot condition as compared with the intact condition. The 6, 8, and 10-mm LCLs showed axial correction of talonavicular alignment by −1.4°, −4.9°, and −9.2° beyond that of the intact foot, and sagittal correction of −0.1°, 1.3°, and 2.9°, respectively. LCL of 6, 8, and 10 mm showed consistently increasing lateral forefoot average mean pressure, peak pressure, and contact area.


LCL in 2-mm increments consistently reduced talonavicular abduction and consistently increased plantar pressure in the lateral aspect of the forefoot.

Clinical Relevance: 

The lateral column should be lengthened judiciously, as a 2-mm difference leads to significant difference not only in angular correction of the talonavicular joint but also with regard to pressure in the lateral aspect of the forefoot.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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