Mid-Calcaneal Length After Evans Calcaneal Osteotomy: A Retrospective Comparison of Wedge Locking Plates and Tricortical Allograft Wedges

Abstract Evans calcaneal osteotomy remains a cornerstone in the correction of the flexible flatfoot. Although multiple techniques have been used to maintain the length of the lateral column, a low profile wedge locking plate was recently introduced as an alternative to the traditional tricortical allograft wedge. We hypothesized that the wedge locking plate would better maintain the mid-calcaneal length compared with the tricortical allograft wedge. To test this hypothesis, after Evans osteotomy, the mid-calcaneal length was measured in the immediate postoperative period and again at 3 and 6 months. A total of 24 patients met the inclusion criteria. The mean patient age was 48.1 years (range 11 to 66). Of the 24 patients, 9 (37.5%) were treated with a tricortical allograft wedge and 15 (62.5%) with a wedge locking plate. At 3 months postoperatively, the mean decrease in mid-calcaneal length was similar for the tricortical allograft wedge group (1.3 ± 1.9 mm) and the wedge locking plate group (0.5 ± 0.9 mm, p = .275). At 6 months postoperatively, however, the mean decrease in mid-calcaneal length was greater for the tricortical allograft wedge group (2.8 ± 1.7 mm) than for the wedge locking plate group (0.6 ± 0.7 mm, p = .004). The 2 groups demonstrated a similar incidence of dorsally displaced distal calcaneal fragments throughout the study endpoint ( p ≥ .052). These results suggest that the wedge locking plate better maintains the mid-calcaneal length over time compared with the tricortical allograft wedge.