3D Patient Specific Lateral Column Lengthening Osteotomy for Flexible Flatfoot

Abstract

Flatfoot is one of the most common clinical presentations in orthopedic practice. When symptomatic flexible flatfoot fails to respond to nonoperative measures, surgical intervention may be necessary. Surgical options include soft tissue and bony procedures. However, deformity correction often requires bony procedures, as soft tissue interventions alone are rarely successful. Evans and Hintermann calcaneal osteotomies are the most commonly used techniques for lateral column lengthening. Despite being performed under fluoroscopic guidance, these osteotomies carry the risk of calcaneal articular surface invasion. Therefore, a more precise and accurate method is needed. This study describes the use of 3D printed patient specific guide for lateral column lengthening osteotomy (LCLO). A CT scan of the affected foot was used for image segmentation via DICOM files to produce a 3D visualization of the calcaneus using 3D Slicer software. A patient specific osteotomy guide designed with anatomic curves to fit the lateral calcaneal surface at the level of the sinus tarsi is 3D printed. The guide directs the osteotomy precisely to the desired direction based on patient calcaneal facet anatomy to avoid articular surface violation. Both Evans and Hintermann osteotomies can be accurately performed using these 3D-printed guides. Postoperative CT scans revealed that the osteotomy was performed as planned, without violation of the articular facets. Patient specific 3D printed guide for lateral column lengthening osteotomy may be a safer and more accurate method to avoid articular surface violation during this demanding osteotomy. Level of Evidence: Diagnostic Level 5.