Calcaneal Osteotomies - Evans, Dwyer, Medalizing, Lateralizing

​What is a calcaneal osteotomy?

A calcaneal osteotomy is a controlled break of the heel bone, performed by an orthopaedic foot and ankle specialist, to correct deformity of the foot and ankle. The calcaneus, or heel bone, plays an important role in walking.

What are the goals of a calcaneal osteotomy?

The heel bone can be moved to achieve a different orientation, which can correct many different deformities and functional limitations.  For example, abnormally high or low arches are deformities that can be addressed with a calcaneal osteotomy. The ultimate goal of all osteotomies is to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis. There are four types of controlled breaks of the heel bone that can be performed: Evans, Dwyer, Medial Shift and Lateral Shift.

What signs indicate an osteotomy may be needed? 

Patients with flatfoot deformity sometimes have an Evans osteotomy. If you look down at your foot, you can see the inside edge of the foot and the outside edge of the foot. For the foot to be straight, the inside edge of the foot and outside edge of the foot must be similar lengths. If the foot is pointed away from the midline then the outside edge of the foot must be functionally shorter. The Evans osteotomy is a controlled break that makes the outside part of the foot longer to help make the foot straight.
Patients with abnormally high arches sometimes have a Dwyer osteotomy. This is a break that removes an outside-based wedge of bone from the calcaneus in order to realign the foot.
Patients who have lost the arch in a foot may have a medializing osteotomy. The heel bone is cut and moved to the inside part of the foot to help restore the arch. Arthritis, loss of tendon function and injury are some causes of a fallen arch.
Another osteotomy for abnormally high arches is the lateralizing osteotomy. The heel is cut and shifted to the outside to reduce the arch and improve alignment.

When should I avoid an osteotomy?

You should not have this procedure if you have an infection or open wound in the area or an inability to follow our surgeon’s instructions after surgery.

General Details of Procedure

Most procedures are approached from the outside of your foot.  Typically, a lateral incision is made in the back of the heel in a direction angled toward the ground. In the case of an Evans osteotomy, the incision is still on the outside of the foot but is more parallel with the ground and closer to the middle of the foot. Dissection is carried down to the outside part of the calcaneus, and a saw is used to make the cut in the bone.

The cut in the bone depends on the type of osteotomy desired. Depending on the procedure, the bone is moved to the desired location and fixed in place. Most often, surgical implants such as screws hold the bones together and support healing.

Specific Techniques

Evans: This is performed vertically and a cut is made 10 mm to 15 mm back from the calcaneocuboid joint (toward the front of the heel bone). Bone graft is then placed in the break, essentially making the outside part of the foot longer. The bone graft can be from a donor or from you. The technical aspects of the procedure will be explained by your surgeon.  
Dwyer: This is usually made with two separate cuts. The cuts are started on the outside part of the calcaneus and converge to a point on the inside of the heel. More bone is removed from the lateral part of the calcaneus and the break is closed and secured with one or two screws.
Medializing: This break is started from the outside part of the calcaneus. A single cut is made with a saw in line with the incision. The cut is made to the inside edge of the calcaneus and then a chisel is used to perforate the inside edge. The free bone fragment is then shifted to the inside and fixed with one or two screws starting in the heel and crossing the break.
Lateralizing: This is similar to the medial break but the heel is shifted to the outside of the foot and secured in the same way.

What happens after the procedure?

You will be placed in a splint or boot. Depending on your surgeon’s preference, the splint may be changed to a cast at the one- or two-week follow-up. You will have to keep weight off your foot for four to six weeks. At that point, progressive weight bearing usually can start. Getting back to regular activities can occur in the three- to six-month range, and swelling will improve slowly.
If you have another foot or ankle procedure done at the same time, your recovery may be longer.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
The potential complications associated with calcaneal osteotomies are nerve and tendon injury, failure of the bone fragments to heal together, loss of correction of the deformity, painful hardware and infection. Your orthopaedic surgeon will discuss the risks and benefits of surgery with you in detail.    

Frequently Asked Questions

What are the chances that my bone will not heal?
This is uncommon and can happen approximately 5 percent of the time. Smoking, infection and poor circulation are all potential risk factors. Should you choose to have surgery, your doctor will discuss these risks with you.
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