Use of 3D Prints to Compare the Efficacy of Three Different Calcaneal Osteotomies for the Correction of Heel Varus.

BACKGROUND: Cavovarus deformity of the hindfoot is typically caused by neurologic disorders. Multiple osteotomies have been described for the correction of varus deformity but without clinical comparison. In this study, we used 18 identical 3-dimensional (3D) prints of a patient with heel varus to compare the operative correction obtained with Dwyer, oblique, and Z osteotomies.

METHODS: A computed tomography (CT) scan of a patient with heel varus was used to create 18 identical 3D prints of the talus, calcaneus, and cuboid. Coordinate frames were added to the talus and calcaneus to evaluate rotation. The prints were then divided into 3 groups of 6 models each. A custom jig precisely and accurately replicated each osteotomy. Following the simulated operations, cut models were CT scanned and compared with 6 uncut models. Measurements were calculated using multiplanar reconstruction image processing. An analysis of variance (ANOVA) was performed on the initial data to determine significant differences among the measured variables. A Tukey Studentized range test was run to compare variables that showed statistically significant differences using the ANOVA.

RESULTS: The coronal angle of the Dwyer and oblique osteotomies was significantly less than that of the Z osteotomy ( P < .05). The axial angle, lateral displacement, and calcaneal shortening of the uncut model and Z osteotomy were significantly less than the Dwyer and oblique osteotomies.

CONCLUSIONS: Dwyer, oblique, and Z osteotomies did not create either lateral translation or coronal rotation without the addition of a lateralizing slide or rotation of the posterior tuberosity.

CLINICAL RELEVANCE: Dwyer and oblique osteotomies would be best suited for mild deformity, yet the amount of calcaneal shortening must be acknowledged. A Z osteotomy is a complex procedure that has the capability of correcting moderate-severe coronal plane rotation but fails to provide lateralization of the pull of the Achilles insertion.