Complications After Minimally Invasive vs Open Calcaneal Osteotomy: A Retrospective Study

Background: A calcaneal osteotomy is a common component of surgical management for various foot and ankle deformities. Open and minimally invasive surgical (MIS) calcaneal osteotomies can be performed. The purpose of this study was to compare complication rates including infection, wound dehiscence, nerve damage, hardware failure, reoperation, and nonunion between these cohorts. Methods: All patients who underwent an open or MIS calcaneal osteotomy between March 2021 and July 2024 at a single institution were identified and retrospectively reviewed. All procedures were performed by one of 2 fellowship-trained orthopaedic foot and ankle surgeons on patients >18 years of age at the time of surgery. These procedures were performed in combination with other procedures to correct planus or cavus feet. Demographic information and postoperative complications were recorded for each patient with a minimum of 12 months follow-up. Results: Forty-four patients who underwent open calcaneal osteotomy and 26 patients who underwent MIS calcaneal osteotomy met the inclusion criteria for the current study. Patients were followed for a mean 25.3 ± 11.1 months. There was no significant difference in the rate of nonunion ( P = .703) or nerve complications ( P = .410) between cohorts. There were fewer postoperative minor wound complications in the MIS cohort (1/26, 3.8%) compared with the open cohort (9/44, 20.5%) ( P = .036) observed in the MIS cohort; however, the P = .036 difference in minor wound complications was found to be not significant after false discovery rate (FDR) adjustment. Conclusion: Data from the current study indicate that open and MIS calcaneal osteotomy are associated with no difference in major complication rates or amount of calcaneal correction. With the numbers available, no significant difference in total or minor complication rates could be detected after FDR adjustment, though fewer minor wound complications were observed in the MIS cohort (3.8% vs 20.5%). Both approaches were associated with significant improvements in patient-reported function and mobility; significant improvement in pain scores was observed in the MIS cohort only after FDR adjustment. Level of Evidence: Level IV, retrospective cohort study.