Joint-Sparing Reconstruction for Progressive Collapsing Foot Deformity: Radiographic Short-term Outcomes and Complications in a Single-Surgeon Cohort

Research Type: Level 4 – Case series Introduction/Purpose: Operative treatment for Progressive Collapsing Foot Deformity (PCFD) is indicated for symptomatic patients who have failed conservative measures, aiming to correct hindfoot valgus (Class A), forefoot/midfoot abduction (Class B), forefoot varus/medial column instability (Class C), and peritalar subluxation (Class D). In flexible PCFD (stage 1), joint-sparing reconstructive procedures preserve mobility of the triple joint complex. These typically include osteotomies, tendon transfers or reattachments, and ligament retensioning/reconstructions. This study analyzed a cohort of PCFD patients who underwent joint-sparing reconstruction by a single surgeon following a standardized protocol, with 3D-measurements derived from Weight Bearing CT (WBCT). We hypothesized that these procedures would achieve significant radiological correction across different PCFD classes. Methods: This IRB-approved retrospective cohort study included 43 adult PCFD patients (24 female, 19 male) with a mean age of 47.8 years (SD 17.8) and mean BMI of 31.0 kg/m² (SD 7.0). All patients underwent joint-sparing reconstructive procedures performed by a single surgeon at a single institution, with a minimum follow-up of three months (mean follow-up 9.3 months). Postoperative management included six weeks of non-weightbearing in a splint/cast and boot, followed by progressive weight-bearing in a boot between week six and twelve. Preoperative and three-month postoperative WBCT scans assessed alignment using a combination of PCFD semiautomated and manual measurements, involving parameters representative for PCFD classes A (Foot and Ankle Offset, Hindfoot Moment Arm), B (Talonavicular Coverage Angle), C (Forefoot Arch Angle, Sagittal Talus First Metatarsal Angle), and D (Middle Facet Subluxation). All surgical procedures performed and any associated complications were recorded. Statistical significance was set at P < .05. Results: Plantarizing first ray procedures (Cotton or Lapicotton) were most frequently performed (100%, mean wedge size 8.2mm), followed by Medial Displacement Calcaneal Osteotomy (MDCO) (93%, mean displacement 9.3mm), Peroneus brevis to longus transfer (86%), posterior tibial tendon (PTT) procedure (84%) and Spring ligament reconstruction (67%). All radiographic parameters showed significant improvement at three months postoperatively (P < 0.01). Three patients (7%) experienced complications. One patient had both a minor complication (superficial wound dehiscence) and a major complication (nonunion MDCO). The other two patients developed sensitive neuritis and nonunion of Lapicotton and MDCO, respectively. Conclusion: This study highlights the potential of reconstructive PCFD surgery, demonstrating promising radiographic short-term radiological outcomes. First ray procedures, MDCO, peroneal and posterior tibial tendon procedures were most frequently performed. While our complication rate aligns with previous literature, we observed two non-unions among 40 MDCO, a higher rate than previously reported. Longer follow-up with WBCT scans is needed to assess the durability of correction. Additionally, studies evaluating clinical outcomes after joint-sparing procedures are warranted.