Medial Displacement Calcaneal Osteotomy (MDCO) is a surgical intervention performed on the foot. This procedure involves a precise modification of the heel bone, known as the calcaneus. Its primary aim is to realign the hindfoot, addressing specific structural imbalances within the foot, and improving foot mechanics and function.
Understanding Flatfoot Deformity
Flatfoot, or flexible pes planovalgus deformity, describes a condition where the arch of the foot collapses and the heel bone tilts outward. This deformity can arise from various factors, including genetic predisposition, ligamentous laxity, or muscle imbalances. Progressive Collapsing Foot Deformity (PCFD) is a common cause, often involving a gradual weakening of the soft tissues that support the arch, leading to the foot slowly losing its natural shape.
Another significant contributor to flatfoot is Posterior Tibial Tendon Dysfunction (PTTD), where the posterior tibial tendon, a major support structure for the arch, becomes inflamed or damaged. As this tendon weakens, it can no longer adequately hold up the arch, leading to its collapse. Symptoms of flatfoot often include pain along the inside of the ankle, arch, or heel, swelling, and difficulty with activities that require standing or walking for extended periods. The altered foot structure can also impact gait patterns, potentially leading to discomfort in the knee, hip, or lower back over time.
How Medial Displacement Calcaneal Osteotomy Works
Medial Displacement Calcaneal Osteotomy (MDCO) directly addresses the hindfoot valgus component of flatfoot by repositioning the calcaneus. The procedure involves making a controlled cut, or osteotomy, through the calcaneus, typically on the lateral (outer) side of the bone. Following this cut, the posterior portion of the calcaneus, specifically the calcaneal tuberosity, is shifted medially, towards the inside of the foot, usually by 10 to 15 millimeters.
This medial shift significantly impacts the biomechanics of the foot. By moving the calcaneal tuberosity medially, the lever arm of the Achilles tendon is effectively lengthened. This allows the Achilles tendon to exert a more efficient supination force on the hindfoot, helping to invert the heel and restore a more neutral alignment. The altered pull of the Achilles tendon reduces the pronatory forces acting on the foot, which contributes to the collapse of the arch. This realignment helps to offload pressure from overloaded areas on the medial side of the foot.
MDCO is rarely performed as a standalone procedure because flatfoot deformity often involves multiple structural issues beyond just hindfoot valgus. It is frequently combined with other surgical interventions to achieve a comprehensive correction. For instance, a flexor digitorum longus (FDL) tendon transfer is commonly performed simultaneously, where a portion of the FDL tendon is rerouted to augment the weakened posterior tibial tendon. This provides additional support to the medial longitudinal arch.
Lateral column lengthening, another frequent co-procedure, involves inserting a bone graft into the outer side of the foot, typically between the calcaneus and cuboid bone. This lengthens the lateral column, which helps to correct forefoot abduction and further restore the arch. These combined procedures work synergistically to address the complex nature of flatfoot, aiming for a stable, functional, and pain-free foot. The specific combination of procedures is tailored to the individual patient’s unique deformity patterns.
Recovery and Rehabilitation
Recovery following a Medial Displacement Calcaneal Osteotomy typically involves several phases, beginning immediately after surgery. Patients usually experience some pain, which is managed with prescribed medications. The foot is typically immobilized in a cast or a walking boot to protect the surgical site and allow the bone to heal. This initial non-weight-bearing period usually lasts for about six to eight weeks to ensure adequate bone fusion.
Progression to weight-bearing is gradual and carefully monitored by the surgeon. Partial weight-bearing, often with crutches or a walker, may begin after the initial immobilization period, slowly increasing over several weeks. Full weight-bearing is usually permitted around 10 to 12 weeks post-surgery, depending on the individual’s healing progress and bone union. Physical therapy plays a central role in rehabilitation, often beginning once the initial pain and swelling subside.
Physical therapy sessions focus on regaining ankle and foot flexibility, strengthening the muscles around the foot and ankle, and improving balance and proprioception. Exercises will gradually increase in intensity, progressing from simple movements to more complex activities. The goal is to restore a normal gait pattern and allow a return to daily activities. Light activities such as walking for exercise may be resumed around three to four months post-surgery, while more demanding activities like running or sports typically require six months to a year, depending on the specific procedures performed and the individual’s recovery trajectory.
Other Treatment Approaches and Considerations
For individuals with flexible flatfoot deformity, non-surgical treatment options are often the first line of approach, particularly in milder cases or for those unwilling to undergo surgery. These conservative measures aim to alleviate symptoms and improve foot mechanics. Custom orthotics, which are specialized shoe inserts, can provide arch support and help redistribute pressure across the foot, reducing strain on affected tendons and ligaments. Physical therapy focuses on strengthening the muscles that support the arch and improving overall foot and ankle mechanics through targeted exercises.
Lifestyle modifications, such as wearing supportive footwear and avoiding prolonged standing or high-impact activities, can also help manage symptoms and prevent progression of the deformity. When conservative treatments do not provide sufficient relief, or if the deformity is severe and progressive, surgical intervention may be considered. Medial Displacement Calcaneal Osteotomy is a prominent procedure, but other surgical approaches exist to address different aspects of flatfoot correction. These may include fusions of specific foot joints, ligament repairs, or other tendon transfers, depending on the specific nature and severity of the deformity.
The decision to proceed with surgery involves careful consideration of several factors. A patient’s overall health status is thoroughly evaluated to ensure they are suitable candidates for surgery. The potential benefits of improved foot function and pain reduction are weighed against the inherent risks associated with any surgical procedure, such as infection, nerve irritation, or delayed healing. Consulting with a foot and ankle specialist is important to discuss the most appropriate treatment plan, considering the individual’s specific condition, lifestyle, and recovery expectations.
References
Paden, B. E., & Stone, M. J. (2020). Medial Displacement Calcaneal Osteotomy. Foot and Ankle Clinics, 25(3), 527-536.