Radiographic improvement of medial column instability after double calcaneal osteotomy without medial column procedures in progressive collapsing foot deformity.

Abstract

Forefoot varus and medial column instability are important components of progressive collapsing foot deformity. Although medial column procedures are commonly performed to address these deformities, their necessity remains controversial. This study evaluated radiographic changes in medial column instability following double calcaneal osteotomy without additional medial column procedures. Retrospective analysis. We retrospectively reviewed 44 feet in 31 patients with stage I progressive collapsing foot deformity who underwent double calcaneal osteotomy without additional medial column procedures. Radiographic parameters of medial column instability, including plantar gapping, first metatarsal lift, sagittal first metatarsal-medial cuneiform angle, and medial arch sag angle, were evaluated preoperatively, at 3 months postoperatively, and at final follow-up. Patients were categorized into stable and unstable groups based on preoperative first tarsometatarsal joint stability. Significant improvements were observed in all radiographic parameters in both groups. In the unstable group, first metatarsal lift improved from 2.71 mm preoperatively to 1.16 mm at final follow-up, and the sagittal first metatarsal-medial cuneiform angle improved from 3.28° to 0.44° (both p value < .001). Although first metatarsal lift remained greater in the unstable group at final follow-up, both groups achieved substantial correction of medial column instability. Overall foot alignment also improved significantly in both groups. Double calcaneal osteotomy without medial column procedures improved radiographic indicators of medial column instability in patients with progressive collapsing foot deformity. Radiographic instability alone may not be sufficient to determine the need for additional medial column procedures when satisfactory correction can be achieved with double calcaneal osteotomy. Level III, retrospective cohort study.