The calcaneus, or heel bone, plays an important role in walking. A calcaneal osteotomy is a controlled break of the heel bone, performed by a foot and ankle orthopaedic surgeon, to correct deformity of the foot and ankle.
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. The ultimate goals of all osteotomies are to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis.
If your pain is worsening or you have a deformity of the foot and ankle that is not responding to other treatments, a calcaneal osteotomy may be part of your surgical reconstruction plan. Discuss your options with your foot and ankle orthopaedic surgeon. If you are at high risk for medical complications, the risks of surgery may outweigh the potential benefits.
A calcaneal osteotomy 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.
In a calcaneal osteotomy, an incision is made on the outer or lateral side of 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 four most common types are the Evans, Dwyer, Medial Shift, and Lateral Shift.
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.
You will be placed in a splint 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.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
The potential complications associated with calcaneal osteotomies are nerve and tendon injury, failure of the bone fragments to heal together, loss of correction of the deformity, painful hardware and infection. Your orthopaedic surgeon will discuss the risks and benefits of surgery with you in detail.
What are the chances that my bone will not heal? This is uncommon and can happen approximately five percent of the time. Smoking, infection, and poor circulation all are potential risk factors. Should you choose to have surgery, your doctor will discuss these risks with you.
Original article by Roy Kellum Jr., MD Last reviewed by David Lee, MD, 2018