Treatment for calcaneal malunion.

BACKGROUND: Pain, limping, and deformity are the most common complications following calcaneal malunion which results from non-operative treatment for calcaneal fractures.

OBJECTIVE: To introduce the experience of treating calcaneal fracture malunion.

METHOD: Between December 2009 and April 2011, eleven patients with calcaneal malunion were treated operatively. Age of patients ranged between 23 and 40 years with an average 28.7. All of them were followed up with a mean 13.5 (9-18 months). Eight of them were right-sided and the other three were left-sided. All of them were male. The mechanism of trauma was fall from a height in all patients. All of them were treated non-operatively since the prime trauma. According to Stephens and Sanders classification, all of cases were type II. The extended lateral calcaneal "L" approach was used in all cases. Lateral wall exostectomy and peroneal tendons are decompressed below the tip of the lateral malleolus and in situ subtalar bone block arthrodesis was done.

RESULT: The mean of American Orthopedic Foot and Ankle Society and pain score systems score was improved from 33 (19-44 points) preoperatively to 69 (42-83 points) postoperatively. The reported complications were superficial wound infection in two cases (18.18%) and reflex sympathetic dystrophy in three cases (27.27%).

CONCLUSION: Calcaneal lateral wall exostectomy, peroneal tenolysis and subtalar joint arthrodesis is an efficient method to treat calcaneal malunion type II after calcaneal fracture by reshaping the calcaneal contour and recovering the hind foot function.

LEVEL OF EVIDENCE: IV.