Management of Malunited Intra articular Fracture of the Calcaneous

Management of Malunited Intra articular Fracture of the Calcaneous | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management of Malunited Intra articular Fracture of the Calcaneous Mohamed Yehia Elsafty, Wael shaban Mahmoud, Mohamed Mokhtar Abd-Ella, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8636186/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and objectives to evaluate calcaneal malunion management through a salvage procedure consisting of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy with malunion type 3 according to Zwipp and Rammelt classification and follow up the outcome of their management. Methods 30 patients with complex intra-articular calcaneal malunion to assess the outcome of their management according to the deformity with subtalar deformity with or without calcaneal osteotomy after approval by the local ethical committee of the university. Results There was a statistically significant increase in the AOFAS score and FAAM score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was an increase in talocalcaneal height and a change in talar declination and lateral talocalcaneal angle at 6 months and 1 year postoperative. Conclusion The use of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy in correcting the malunited calcaneal fractures is associated with significant improvement without the occurrence of major complications. Calcaneal malunion subtalar arthritis Heel valgus subtalar arthrodesis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The calcaneus is the most common type of tarsal bone fracture [ 1 ] accounting for 2% of all fractures. Most calcaneus fractures are the result of high-energy trauma, like a car crash or a fall from a great height. Of all fractures, 60–75% are displaced intra-articular injuries [ 2 ] . Calcaneus fractures can cause patient disability, economic burden, and treatment challenges for the average orthopaedic surgeon [ 3 ] . Inappropriate conservative or surgical treatment can cause calcaneal malunion and severe traumatic subtalar arthritis due to the hindfoot structure's intricacy and high-energy trauma [ 4 ] . Subtalar joint depression, arch collapse, calcaneus widening, and hindfoot varus/valgus deformity typically accompany calcaneal malunion, causing considerable discomfort and incapacity [ 5 ] . The extent of malunion can be described using two standard classification systems. Stephens and Sanders classify 3 types: Type I is lateral wall exostosis with minor lateral joint arthrosis; type II has severe subtalar joint arthrosis; and type III has hind foot varus over 10° [ 6 ] . Meanwhile, Zwipp and Rammelt's classification has six types: Lateral exostosis without subtalar arthritis; subtalar incongruency, normal calcaneal morphology; heel varus or valgus; hindfoot height loss; lateral translation of the calcaneal tuberosity and talar tilt or dorsiflexion past neutral [ 5 ] . In cases of malunited calcaneal fractures, the goals of treatment include raising the patient's calcaneal height, mending the talocalcaneal connection, and developing a stable, plantigrade foot. To alleviate symptoms and restore function, corrective calcaneal osteotomy, with or without arthrodesis, is the therapy of choice [ 2 ] . This study between our hands was conducted to evaluate calcaneal malunion management through a salvage procedure consisting of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy with malunion type 3 according to Zwipp and Rammelt classification and follow up the outcome of their management. Patients and methods Ethics approval and Consent: This was a prospective interventional study that was done at the Orthopedic Surgery Department of Al Zahraa University Hospital,(Cairo, Egypt). The study period extended from April 2023 to April 2025, during which patients were consecutively recruited and followed up for at least 12 months postoperatively. The study was approved via the Institutional Review Board of Al-Zahraa University Faculty of Medicine, and it was given the following code: 1836/15-3-2023. Clinical Trial Number Not Applicable. This study involved 30 male and female patients in the age between 16 and 60 years with unilateral or Bilateral malunited -articular calcaneal fixation of 6 of 6 months or older of injury, subtalar arthritis and deformity ± Loss of height. Patients with active infection or bad soft tissue coverage, duration of fractures of less than 6 months, diabetic patients or any neurovascular affection, paralytic limb, ipsilateral knee, contralateral knee, hip or spine problems may affect the outcome, CRPS and suicidal patients were excluded from the study. All patients were subjected to the following preoperative evaluation including f ull history taking mainly the mode of trauma, clinical evaluation through (AOFAS), subjective evaluation through (FAAM) score, preoperative laboratory investigation and radiological evaluation (anteroposterior and lateral weight bearing radiographs and CT scans of the ankle and foot). The talar inclination angle, talocalcaneal angle, and talocalcaneal height was assessed in the lateral weight-bearing radiograph, while the heel valgus angle was assessed in the coronal cuts of the CT scan by superimposing the cut taken at the midankle joint and the cut taken at the midposterior subtalar joint; the angle is created by the intersection of the tibial axis and the heel bisector. The fracture malunion is classified using the Zwipp and Rammelt classification methods. Surgical technique The operation was done under spinal or general anesthesia. Patients were placed in lateral decubitus on the unaffected side using a thigh tourniquet. Each patient received intravenous antibiotics before surgery. Lateral extensile and sinus tarsi methods were applied. To prevent sural nerve injury, the posterior arm of the incision was inserted between the fibula and Achilles tendon in the lateral extensile approach. The horizontal arm was aligned with the fifth metatarsal base to avoid cutaneous issues. A full-thick flap was created. Figure (1): The lateral extensile approach was opened. Lateral wall exostectomy was performed with an osteotome to clear the fibula tip. An oblique lateral closure calcaneal osteotomy was performed from a superior point anterior to the Achilles tendon to an inferior point anterior to the posterior calcaneal tuberosity. A saw added a parallel limb 1 cm anterior to the other. Both osteotomy limbs joined at the calcaneus medial cortex (severe varus deformity may require lateral translation). Figure (2) Lateral wall osteotomy using an osteotome. Visualizing the subtalar joint with a lamina spreader. To obtain bleeding surfaces, remaining cartilage and sclerotic subchondral bone of the talar and calcaneal joints were removed. Talus-calcaneus surface congruency was carefully checked. Grafting used cancellous bone from exostectomy and osteotomy wedge. In all patients, two 6.5-mm screws fixed the osteotomy and arthrodesis site. Screws were introduced from the posteroinferior calcaneus to the center of the talus to close the wound in layers. Figure (3): Two parallel guide wire for the screws. Figure (4): Two parallel screws for the fusion. Postoperative Follow Up: For two weeks, a short-leg splint healed soft tissue. After two weeks, sutures were removed and a short-leg circular cast was fitted. At 3, 6, and 12 months postoperatively, AOFAS, VAS, and FAAM were reassessed in all patients. Control radiographs were taken on the first day postoperatively, after three and six weeks, and after three and six months. Radiographs used to assess osteotomy and subtalar joint union. Crossing trabeculae at the fusion site and osteotomy confirmed calcaneal osteotomy-subtalar fusion union. The last follow-up at 12 months included weight-bearing anteroposterior and lateral radiographs. Imaging investigations measured valgus angle, talocalcaneal angle, height, and talar inclination angle. Statistical analysis of data The data collected were coded, processed and analyzed with Statistical Package for Social Sciences (SPSS) version 26 for Windows® (IBM, SPSS Inc, Chicago, IL, USA). Qualitative data were shown as number (frequency) and percent. The Kolmogorov-Smirnov test tested quantitative data for normality. Parametric data were shown as median ± SD while non-parametric data were expressed as median (range). Mann Whitney Test (U test) was used to assess the statistical significance of the difference between two independent study group with non-parametric data. Repeated measures ANOVA Test was used to assess the statistical significance of the difference between quantitative variables at different tie points, with paired samples t-test being used as a comparative tool between two time points. The differences were considered statistically significant when the P value was ≤ 0.05. Results The current study included 30 cases with malunited intraarticular fracture of the calcaneus. As shown in this table (1), the mean age of the cases was 35.03 ± 9.27 years with a range between 17 and 53 years. There were 22 males (73.3%) and 8 females (26.7%). This table also shows that the mean duration from primary fixation till arthrodesis was 29.80 ± 30.05 months, with a range between 8 and 132 months. The right side was affected in 13 cases (43.3%), while the left side was affected in 17 cases (56.7%). Varus deformity was shown in 5 cases (16.7%), while valgus deformity was shown in 25 cases (83.3%). There were 11 cases (36.7%) who had one previous operation, 1 case (3.3%) with two previous operations, and 1 case (3.3%) with three previous operations. Table (1) Basic data in the cases of the study. Variables Study cases N = 30 Mean ± SD Median (Range) Age (years) 35.03 ± 9.27 36 (17–53) Number Percent Sex Males 22 73.3 Females 8 26.7 Mean ± SD Median (Range) Time from primary fixation till arthrodesis (months) 29.80 ± 30.05 22 (8–132) Number Percent Side Right 13 43.3 Left 17 56.7 Heel deformity Varus 5 16.7 Valgus 25 83.3 Number of previous surgery No operations 17 56.7 One operation 11 36.7 Two operations 1 3.3 Three operations 1 3.3 Table (2) shows that the performed operative techniques were arthrodesis + calcaneal osteotomy in 7 cases (23.3%), calcaneoplasty + arthrodesis in 3 cases (10%), calcaneoplasty + distraction arthrodesis in one case (3.3%), distraction arthrodesis in 18 cases (60%) and subtalar arthrodesis in one case (3.3%). Associated operation (iliac bone graft) was required in 10 cases (33.3%). No intraoperative complications were reported. Table (2) also shows that there were 3 cases (10%) who had postoperative complications in the form of infection. No cases required additional operations. This table shows that at 6 months postoperative, all the patients were satisfied. Table (2) Operative and postoperative data in the cases of the study. Variables Study cases N = 30 Number Percent Operative technique Arthrodesis + Calcaneal osteotomy 7 23.3 Calcaneoplasty + Arthrodesis 3 10 Calcaneoplasty + distraction arthrodesis 1 3.3 Distraction Arthrodesis 18 60 Subtalar arthrodesis 1 3.3 Associated procedures No 20 66.7 Iliac bone graft 10 33.3 Intraoperative complications No 30 100 Patient satisfaction (At 6 months postoperative) Satisfied 30 100 Postoperative complications No 27 90 Infection 3 10 Need for other operations No 30 100 Figure (5) Operative technique in the cases of the study As shown in table (3), there was a statistically significant increase in the FAAM Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the FAAM Score at 1 year postoperative as compared to 6 months value. There was a statistically significant increase in the AOFAS Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the AOFAS Score at 1 year postoperative as compared to 6 months value. There was a statistically significant increase in the Talar declination angle at 6 months and 1 year postoperative as compared to the preoperative value. There was a statistically significant decrease in the Talar declination angle at 6 months and 1 year postoperative as compared to the preoperative value. There was a statistically significant increase in the lateral talocalcaneal angle at 6 months and 1 year postoperative as compared to the preoperative value. There was a statistically significant decrease in the lateral talocalcaneal angle at 6 months and 1 year postoperative as compared to the preoperative value. There was a statistically significant increase in the talocalcaneal height at 6 months and 1 year postoperative as compared to the preoperative value. Table (3) Follow up of the different scores at preoperative, 6 months postoperative and 1 year postoperative Variable Preoperative (N = 30) At 6 months postoperative (N = 30) At 1 year postoperative (N = 30) Percent of change P value FAAM Score Mean ± SD 60.07 ± 6.01 80.97 ± 3.04 84.52 ± 2.52 38.71 (16.8 : 105.26) F = 381.142 P < 0.001 * P1 < 0.001 * < 0.001 * P2 < 0.001 * AOFAS Score Mean ± SD 0.59 ± 0.05 0.81 ± 0.02 0.85 ± 0.02 41.17 (9.71 : 66) F = 348.613 P < 0.001 * P1 < 0.001 * < 0.001 * P2 < 0.001 * Talar declination angle (in varus cases) Mean ± SD 12 ± 0.71 23.4 ± 6.07 23.4 ± 6.07 -66.67 (-172.73 : -38.46) F = 15.007 P = 0.018* P1 < 0.001 * < 0.001 * P2 1 Talar declination angle (in valgus cases) Mean ± SD 37.68 ± 1.38 32.44 ± 1.80 32.44 ± 1.80 11.11 (7.89 : 28.95) F = 7.426 P = 0.039* P1 0.048* 0.048* P2 1 Lateral talocalcaneal angle (in varus cases) Mean ± SD 21.40 ± 1.14 31.80 ± 5.07 31.80 ± 5.07 − 50 (-80 : − 13.04) F = 15.472 P < 0.001 * P1 < 0.001 * < 0.001 * P2 1 Lateral talocalcaneal angle (in valgus cases) Mean ± SD 45.16 ± 2.61 38.04 ± 1.65 38.04 ± 1.65 16.67 (7.14 : 26.53) F = 9.456 P = 0.020 * P1 0.034 * 0.034 * P2 1 Talocalcaneal height Mean ± SD 58.90 ± 3.21 68.10 ± 2.93 68.10 ± 2.93 16.03 (-10.45 : 30.91) F = 32.198 P < 0.001 * P1 < 0.001 * < 0.001 * P2 1 P: probability. F: Repeated measures ANOVA *: Statistically significant (p < 0.05) P1: Significance in relation to preoperative data P2: Significance in relation to 6 months postoperative The following table shows that there was no statistically significant difference between the cases with different age groups regrading FAAM percent of change, AOFAS Percent of change, Talar declination percent of change, Lateral talocalcaneal angle percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value. Table (4) Analysis of the percent of change of the tested parameters according to the age groups Variables Age ≤ 40 years (N = 21) Age > 40 years (N = 9) P value FAAM percent of change 38.71 (22.73 : 105.26) 40.16 (26.15 : 58.18) 0.864 AOFAS Percent of change 41.94 (25.37 : 60.38) 38.71 (32.31 : 66) 0.717 Talar declination percent of change 10.81 (-150 : 28.95) 11.11 (-172.73 : 17.95) 0.712 Lateral talocalcaneal angle percent of change 15.21 (-76.19 : 26.53) 16.67 (-80 : 18.37) 0.874 Talocalcaneal height percent of change 15 (-10.45 : 30.77) 18.18 (12.7 : 30.91) 0.147 Table (5) shows that there was no statistically significant difference between the male and female cases regrading FAAM percent of change, AOFAS Percent of change, Talar declination percent of change, Lateral talocalcaneal angle percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value. Table (5) Analysis of the percent of change of the tested parameters according to the gender Variables Males (N = 22) Females (N = 8) P value FAAM percent of change 40.68 (25.76 : 105.26) 31.54 (22.73 : 60.38) 0.196 AOFAS Percent of change 39.69 (25.37 : 60.38) 48.73 (31.75 : 66) 0.231 Talar declination percent of change 10.81 (-172.73 : 28.95) 12.49 (-38.46 : 20.51) 0.778 Lateral talocalcaneal angle percent of change 13.95 (-80 : 26.53) 16.29 (-28.57 : 18.37) 0.453 Talocalcaneal height percent of change 16.95 (-10.45 : 30.91) 14.28 (8.33 : 27.27) 0.280 Table (6) shows that there was no statistically significant difference between the cases with affected right or left sides regrading FAAM percent of change, AOFAS Percent of change, Talar declination percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value. While Lateral talocalcaneal angle percent of change was statistically significantly higher in the left side. Table (6) Analysis of the percent of change of the tested parameters according to the affected side Variables Right (N = 13) Left (N = 17) P value FAAM percent of change 38.67 (29.23 : 76) 38.71 (22.73 : 105.26) 0.842 AOFAS Percent of change 38.33 (30.30 : 60.38) 44.83 (25.37 : 66) 0.544 Talar declination percent of change 8.33 (-172.73 : 23.08) 11.11 (-38.46 : 28.95) 0.056 Lateral talocalcaneal angle percent of change 11.11 (-80 : 26.53) 17.02 (-28.57 : 24.49) 0.049* Talocalcaneal height percent of change 17.54 (8.33 : 29.63) 15 (-10.45 : 30.91) 0.102 *: Statistically significant (p < 0.05) Table (7) shows that there was no statistically significant difference between the cases with varus or valgus deformity regrading FAAM percent of change, AOFAS Percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value. While Talar declination percent of change and Lateral talocalcaneal angle percent of change were statistically significantly higher in the valgus deformity. Table (7) Analysis of the percent of change of the tested parameters according to the Heel deformity Variables Varus (N = 5) Valgus (N = 25) P value FAAM percent of change 38.71 (29.03 : 46.55) 38.71 (22.73 : 105.26) 0.752 AOFAS Percent of change 41.67 (38.33 : 57.69) 38.71 (25.37 : 66) 0.316 Talar declination percent of change -66.67 (-172.73 : -38.46) 11.11 (7.89 : 28.95) < 0.001* Lateral talocalcaneal angle percent of change − 50 (− 80 : − 13.04) 16.67 (7.14 : 26.53) < 0.001* Talocalcaneal height percent of change 16.95 (10.53 : 29.63) 15.39 (-10.45 : 30.91) 0.578 *: Statistically significant (p < 0.05) Discussion The current study was conducted to evaluate calcaneal malunion management through a salvage procedure consisting of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy with malunion type 3 according to Zwipp and Rammelt classification and follow up the outcome of their management. The current study included 30 cases with malunited intraarticular fracture of the calcaneus who were recruited from the orthopedics department at Al- Zhraa University Hospitals. In this study, the mean age of the cases was 35.03 ± 9.27 years with range between 17 and 53 years. There were 22 males (73.3%) and 8 females (26.7%). The results agreed with those of Abouelsoud cleared that the mean age was 34.83 (range, 22–46) years old. There was male predominance as male:female ratio was 19:4 [ 7 ] . This was also in accordance with Mar'ei et al. who included 24 cases with malunited calcaneal fractures and showed that there were 20 male (83.3%) and 4 females (16.7%), the oldest was 58 with a mean of 40.9 years (SD = ± 10.3) [ 8 ] . In the current study, the mean duration from primary fixation till arthrodesis was 29.80 ± 30.05 months with range between 8 and 132 months. A research by Guan et al. involved 170 patients (184 feet) with a weighted mean age of 37.6 who underwent reconstructive calcaneal operations with/without subtalar arthrodesis at 15.4 months following first injury. The mean follow-up was 42.8 months [ 2 ] . The differences in the interval duration between the studies could be due to variation in the healthcare facilities and protocols of different centers. In the current study, the right side was affected in 13 cases (43.3%) while the left side was affected in 17 cases (56.7%). Varus deformity was shown in 5 cases (16.7%) while valgus deformity was shown in 25 cases (83.3%). Zeynalov and Arapova found that varus and valgus deformity were approximately equally distributed in twelve individuals with post-traumatic deformed hindfoots following malunited calcaneal fractures (5/7) ([ 9 ] . This illustrates that both deformities can occur and there is no prevalence of one over the other reported in the literature. Calcaneal varus, which partly transfers weight-bearing to the lateral side of the foot, can develop from a malunited calcaneal fracture with superior translation of the tuberosity, affecting hindfoot biomechanics. Long-term severe varus hindfoot may cause heel eversion in early stance phase, reducing shock absorption and increasing injury risk [ 10 ] . Lateral wall exostosis from unified lateral wall blow-out and superolateral translation causes calcaneal valgus deformity and heel broadening. Calcaneofibular impingement, pseudoarticulation, and peroneal tendinosis can result from exostosis, altering lower limb posture and muscle strength [ 11 ] . The efficacy of surgical procedures can assist doctors tailor treatment to the patient's condition. With 29 patients, Agren et al. conducted in situ subtalar arthrodesis. X-ray and CT scans revealed substantial residual abnormalities in afflicted limbs, suggesting in situ subtalar arthrodesis may not be the optimal treatment for severe calcaneal malunion after a 7–28 year follow-up [ 12 ] . Some academics have incorporated Dwyer osteotomy to treat hindfoot angular deformity following in situ subtalar arthrodesis, although this cannot restore calcaneal height or subtalar joint collapse [ 13 ] . Huang et al. treated calcaneal malunion by calcaneal metatarsal slip osteotomy and subtalar arthrodesis, like our osteotomy. It cannot establish direct and full contact with the cleansed calcaneal articular surface, and it is susceptible to lose length. After the calcaneal malunion, extra-articular osteotomy is harder to restore the subtalar joint's good match due to the fibrous scar tissue between the calcaneocuboid joint and talocalcaneal interosseous. Second, bone grafts are typically needed to cover the subtalar joint area, and their resorption might cause further fusion failures including partial fusion or lack of union [ 14 ] . In this study, arthrodesis plus calcaneus osteotomy was used in seven cases (23.3%), calcaneoplasty plus arthrodesis in three cases (10%), calcaneoplasty plus distraction arthrodesis in one case (3.3%), distraction arthrodesis in eighteen cases (60%), and subtalar arthrodesis in one case (3.3%) within the present investigation. The use of an iliac bone graft was necessary in 10 patients (33.3%). We tracked surgery improvement with AOFAS score, but now there is a focus on patient-reported outcome metrics without healthcare provider interpretation [ 15 ] . As a result, we evaluated the function using FAAM score. Because of how bad the injury is, the AOFAS and FAAM scores are poor. There was a statistically significant increase in the FAAM Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the FAAM Score at 1 year postoperative as compared to 6 months value. Also, there was a statistically significant increase in the AOFAS Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the AOFAS Score at 1 year postoperative as compared to 6 months value. According to Mar'ei et al., the mean and range of the AOFAS score before and after adjustment was found to be highly considerably improved after correction, from 24.8 (10–49) to 73.9 (58–90) [ 8 ] . Our results confirmed these findings. Our findings align with Wang et al., who reported a significantly higher postoperative American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score (86.3 ± 4.45, t = 27.64, P < 0.0001, paired t-test) than pretreatment [ 16 ] . Bai et al. also examined medical records and imaging of 11 calcaneus malunion patients who underwent Y-shape osteotomy and subtalar arthrodesis. The post-operative mean AOFAS score enhanced from 34.18 ± 9.53 to 84.18 ± 11.59 (p < 0.05) [ 4 ] . In the research conducted by Zeynalov and Arapova, it was discovered that there was a substantial improvement in AOFAS, which went from 55.2 before surgery to 78.8 after 24 months [ 9 ] . Woo et al. examined 51 people in 57 calcaneal malunion cases from March 2006 to December 2017. Patients were observed for 22.8 months on average. SDA handled all cases. Data demonstrated that average AOFAS scores at 3, 6, and 12 months after surgery improved statistically over preoperative values [ 17 ] . Further, the average FAAM ADL score increased from 31.4% before surgery to 74.2% afterward, and the average AOFAS score increased from 23.4 before surgery to 69.6% afterward, according to Niazi et al. [ 18 ] . Eid et al. stated that there was a 94% union rate and a significant improvement in the AOFAS scores in all of their patients when they used the same mending approach [ 19 ] . In our study, Talar declination angle, lateral talocalcaneal angle and talocalcaneal height showed a statistically significant improvement after correction surgery as compared to preoperative value. Having the hindfoot varus angled or the foot in dorsiflexion causes the angle to decrease during the malunion. When one bends at the knee or plants one foot forward, the talocalcaneal angle widens [ 20 ] . So, the opposite occur after correction. We agreed with Mar'ei et al., who found that all radiological parameters, including TCA, TDA, CPA, and TCH, increased significantly and statistically postoperatively than preoperatively [ 8 ] Consistent with Wang et al., we found that talocalcaneal height (65.15–72.68 mm), Calcaneus-talus angle (from 34.46° to 39.7°), and Böhler's angle (from 25.4° to 86.3°) all improved significantly after surgery. A patient had some discomfort following a vigorous 1-hour stroll [ 16 ] Radiographers Zeynalov and Arapova found a considerable improvement in a number of parameters, including talar tilt, height of calcaneus, Meary's angle, and hindfoot varus/valgus [ 9 ] . Bai et al. found that patients' radiographic parameters—Böhler angle, pitch angle, calcaneal width, talocalcaneal height, and hindfoot alignment angle—improved significantly at the last follow-up. No triceps surae contracture, peroneal tendinitis, anterior ankle impingement, or other issues were seen [ 4 ] . In the same context, Bai et al. found that patients' Böhler angle, pitch angle, calcaneal width, talocalcaneal height, and hindfoot alignment angle were much better at the last follow-up than pre-op. Patients had no triceps surae contracture, peroneal tendinitis, anterior ankle impingement, or other issues [ 21 ] . Henning et al. found that subtalar arthrodesis improved talocalcaneal height from pre to after values (p = 0.04) [ 22 ] . After treating 17 cases of malunited calcaneal fractures of the Stephens Type ⅏ with in situ subtalar arthrodesis, Savva and Saxby found that the average talar inclination angle was only restored to 36% of the normal side [ 23 ] In this study, there were 3 cases (10%) who had postoperative complications in the form of infection. No cases required additional operations. Three heels (13% of the total) had problems such as infection and nonunion in the research by Kassem et al. One patient sustained damage to the sural nerve, and two heels exhibited residual varus following surgery [ 24 ] . One incidence of a problem requiring removal of noticeable hardware was reported in the study by Mar'ei et al. One case had a superficial infection and one case had a deep infection; four cases had varus malalignment of more than 5º relative to the anatomical alignment; one case's symptoms improved after orthotic treatment and shoe modifications, while the other case is still symptomatic. Six cases had delayed wound healing. Four instances were found to have sural nerve damage. Six patients experienced persistent swelling in the lower extremities after surgery. Four patients had mild ankle arthritis, and two individuals had significant calcaneocuboid joint arthritis [ 8 ] . The cumulative incidence of problems was 38% (106/278) in the meta-analysis by Thompson and Roukis. This is despite the fact that complications are reported for all treatments rather than per patient, meaning that many patients had several difficulties. Consequently, one complication occurs for every 2.6 treatments of calcaneal malunion with bone block distraction subtalar arthrodesis. Problems with soft tissues or bones could be either minor or substantial. There were 45 occurrences of minor soft tissue troubles (16.2%) and 37 cases of light bone difficulties (13.3%). Brief paresthesia and non-surgical superficial infections of soft tissues were identified as instances of mild soft tissue issues. Removing hardware and modifying or removing the shoe gear were necessary procedures for lateral calcaneal wall exostosis, one of the minor bone issues. In all, 278 procedures had six serious problems with soft tissues (2.2%) and eighteen with bones (6.5%) [ 25 ] . The systematic analysis conducted by Schepers revealed that 106 issues, or 38% of the 278 operations examined, were encountered. Of those, 82 were deemed moderate issues, while 24 were deemed significant [ 26 ] . This reflects that correction of malunion calcaneal fractures are relatively safe with low rate of complications. Conclusion Due to fracture pattern complexity and soft tissue envelope limitations, orthopedic surgeons will continue to struggle with calcaneal fracture therapy. Correction of malunited calcaneal fractures using subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy improves outcomes without substantial problems. There is no international consensus on surgical anatomic reduction and fixation, although trends suggest it is the best way to improve patient satisfaction and reduce post-traumatic osteoarthritis. Declarations Ethics approval and consent to participate: The study was approved via the Institutional Review Board of Al-Zahraa University Faculty of Medicine, and it was given the following code: 1836/15-3-2023. Consent for publication: All participants provided written informed consent for publication. Competing interests: No benefits in any form have been received or will be received related directly to this article. Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article. Author Contribution Moha Elsafty Agree to be accountable for all aspects of the work in ensuringthat questions related to the accuracy or integrity of any part of the work are investigated and resolved, Wael Shaban Approved the version to be published , Moha Abd Ella Had the idea for the article , Moha Abd Elfattah Drafted the work and prepared the figures. Acknowledgement we would like to thank Dr.Awab Ali for his contribution to the study. Data Availability The data that support the findings of this study are available on request from the corresponding author. References Chotikkakamthorn N, Chanajit A, Tharmviboonsri T, Chuckpaiwong B, Harnroongroj T. Minimal invasive surgery in the management of intra-articular calcaneal fractures: A retrospective comparison of screw fixation alone versus screw with small locking plate fixation techniques. 2020. Guan X, Xiang D, Hu Y, Jiang G, Yu B, Wang B. Malunited calcaneal fracture: the role and technique of osteotomy—a systematic review. Int Orthop. 2021;45:2663–78. Giannini S, Cadossi M, Mosca M, Tedesco G, Sambri A, Terrando S, et al. Minimally-invasive treatment of calcaneal fractures: A review of the literature and our experience. Injury. 2016;47:S138–46. Bai W, Zhu Y, Xu J, Liang J, Lu J. Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res. 2022;17(1):526. Rammelt S, Marx C. Managing severely malunited calcaneal fractures and fracture-dislocations. Foot Ankle Clin. 2020;25(2):239–56. Stephens HM, Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int. 1996;17(7):395–401. Abou Elsoud AA, Salama AM, Al Adawy AM. Limited Invasive Techniques in Management of Sander's Type II, III Calcaneal Fractures. Egypt J Hosp Med. 2021;85(2):3561–4. Mar'ei MM, Attia ME, Salama Shaaban AM, Elgawhary SA. Distraction Subtalar Arthrodesis after Malunited Calcaneal Fractures. Zagazig Univ Med J. 2025;31(2):575–85. Zeynalov V, Arapova I. Calcaneal Malunions Management and Types of Surgical Correction. Foot Ankle Orthop. 2022;7(4):2473011421S01015. Banerjee R, Saltzman C, Anderson RB, Nickisch F. Management of calcaneal malunion. JAAOS-Journal Am Acad Orthop Surg. 2011;19(1):27–36. Yu G-R, Yu X. Surgical Management of Calcaneal Malunion. J Orthop Trauma Rehabilitation. 2013;17(1):2–8. Ågren P-H, Tullberg T, Mukka S, Wretenberg P, Sayed-Noor AS. Post-traumatic in situ fusion after calcaneal fractures: a retrospective study with 7–28 years follow-up. Foot Ankle Surg. 2015;21(1):56–9. Ketz J, Clare M, Sanders R. Corrective osteotomies for malunited extra-articular calcaneal fractures. Foot Ankle Clin. 2016;21(1):135–45. Huang P-J, Fu Y-C, Cheng Y-M, Lin S-Y. Subtalar arthrodesis for late sequelae of calcaneal fractures: fusion in situ versus fusion with sliding corrective osteotomy. Foot Ankle Int. 1999;20(3):166–70. Kitaoka HB, Meeker JE, Phisitkul P, Adams SB Jr, Kaplan JR, Wagner E. AOFAS position statement regarding patient-reported outcome measures. Foot Ankle Int. 2018;39(12):1389–93. Wang B, Guan X, Hu Y, Jiang G, Lin Q, Ye J, et al. Multiple reconstructive osteotomy treating malunited calcaneal fractures without subtalar joint fusion. Orthop Surg. 2023;15(3):810–8. Woo SH, Goh T-S, Ahn T-Y, You JS, Bae S-Y, Chung H-J. Subtalar distraction arthrodesis for calcaneal malunion-comparison of structural freeze-dried versus autologous iliac bone graft. Injury. 2021;52(4):1048–53. Niazi NS, Aljawadi A, Pillai A. Shaped titanium wedges for subtalar distraction arthrodesis: Early clinical and radiological results. Foot. 2020;42:101647. Eid MAM, El-Soud MA, Mahran MA, El-Hussieni TF. Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft. Strategies trauma limb reconstruction. 2010;5:39–45. Aly T. Management of valgus extra-articular calcaneus fracture malunions with a lateral opening wedge osteotomy. J foot ankle Surg. 2011;50(6):703–6. Sundararajan SR, Ramakanth R, Shreeram V, Joseph JB, Rajasekaran S. Is distraction bone block Arthrodesis better than subtalar arthrodesis for malunited calcaneal fractures with subtalar arthritis? A retrospective case series. J Foot Ankle Surg (Asia Pacific). 2021;8(1):3–7. Henning C, Poglia G, Leie MA, Galia CR. Comparative study of subtalar arthrodesis after calcaneal frature malunion with autologous bone graft or freeze-dried xenograft. J Experimental Orthop. 2015;2:1–9. Savva N, Saxby TS. In situ arthrodesis with lateral-wall ostectomy for the sequelae of fracture of the os calcis. J Bone Joint Surg Br Volume. 2007;89(7):919–24. Kassem MS, Elgeidi A, Badran M, Farag F. Sagittal Resection Osteotomy With Bone Block Distraction Subtalar Fusion for Treatment of Malunited Calcaneal Fractures. J Foot Ankle Surg. 2019;58(4):739–47. Thompson MJ, Roukis TS. Management of Calcaneal Fracture Malunion with Bone Block Distraction Arthrodesis: A Systematic Review and Meta-Analysis. Clin Podiatr Med Surg. 2018;36(2):307–21. Schepers T. The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: a systematic review. Foot. 2013;23(1):39–44. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8636186","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607478999,"identity":"2c1e88f3-2941-4d52-947a-e74690ca8922","order_by":0,"name":"Mohamed Yehia Elsafty","email":"data:image/png;base64,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","orcid":"","institution":"Al Azhar University","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"Yehia","lastName":"Elsafty","suffix":""},{"id":607479000,"identity":"13130271-cdbb-4934-b98e-f11bd5af26fd","order_by":1,"name":"Wael shaban Mahmoud","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Wael","middleName":"shaban","lastName":"Mahmoud","suffix":""},{"id":607479001,"identity":"47f4938f-885d-4e12-b80f-e6d4be5fa079","order_by":2,"name":"Mohamed Mokhtar Abd-Ella","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Mokhtar","lastName":"Abd-Ella","suffix":""},{"id":607479002,"identity":"7bcae518-e4fe-4c76-bb8c-569a9078c203","order_by":3,"name":"Mohamed Ahmed Abdelfattah","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Ahmed","lastName":"Abdelfattah","suffix":""}],"badges":[],"createdAt":"2026-01-19 08:29:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8636186/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8636186/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104997252,"identity":"484a6b93-c624-4435-bbc2-b7fccb6555f1","added_by":"auto","created_at":"2026-03-19 16:21:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":762693,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe\u003c/strong\u003e lateral extensile approach was opened.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8636186/v1/f85ff749655d78ca9787465d.png"},{"id":105035675,"identity":"ae79d57d-5ca5-4502-bbeb-369e62f63894","added_by":"auto","created_at":"2026-03-20 07:26:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":609738,"visible":true,"origin":"","legend":"\u003cp\u003eLateral wall osteotomy using an osteotome.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8636186/v1/82ae294b1ef7537129c9c746.png"},{"id":104997251,"identity":"a3f9df55-cab3-4146-9898-80b142a0f697","added_by":"auto","created_at":"2026-03-19 16:21:43","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":51356,"visible":true,"origin":"","legend":"\u003cp\u003eTwo parallel guide wire for the screws.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8636186/v1/e132388d72f0f95dcda20223.jpg"},{"id":104997255,"identity":"97a5f3ef-afe8-4361-af60-01a34972cb54","added_by":"auto","created_at":"2026-03-19 16:21:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":332283,"visible":true,"origin":"","legend":"\u003cp\u003eTwo parallel screws for the fusion.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8636186/v1/b5d0c1b32988c702e20fff05.png"},{"id":104997253,"identity":"9ffc374a-d672-4bf9-a331-8d34632d6605","added_by":"auto","created_at":"2026-03-19 16:21:43","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":362486,"visible":true,"origin":"","legend":"\u003cp\u003eOperative technique in the cases of the study\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8636186/v1/0e0ddc430ea1d2ba821aa40b.png"},{"id":105904883,"identity":"1fc5e723-5f32-49da-a4f9-2f77c06d765f","added_by":"auto","created_at":"2026-04-01 10:10:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3220524,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8636186/v1/2a16b657-a8a9-458d-b603-fe8bfe6ceaf8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management of Malunited Intra articular Fracture of the Calcaneous","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe calcaneus is the most common type of tarsal bone fracture \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e accounting for 2% of all fractures. Most calcaneus fractures are the result of high-energy trauma, like a car crash or a fall from a great height. Of all fractures, 60\u0026ndash;75% are displaced intra-articular injuries \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCalcaneus fractures can cause patient disability, economic burden, and treatment challenges for the average orthopaedic surgeon \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInappropriate conservative or surgical treatment can cause calcaneal malunion and severe traumatic subtalar arthritis due to the hindfoot structure's intricacy and high-energy trauma \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSubtalar joint depression, arch collapse, calcaneus widening, and hindfoot varus/valgus deformity typically accompany calcaneal malunion, causing considerable discomfort and incapacity \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe extent of malunion can be described using two standard classification systems. Stephens and Sanders classify 3 types: Type I is lateral wall exostosis with minor lateral joint arthrosis; type II has severe subtalar joint arthrosis; and type III has hind foot varus over 10\u0026deg; \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMeanwhile, Zwipp and Rammelt's classification has six types: Lateral exostosis without subtalar arthritis; subtalar incongruency, normal calcaneal morphology; heel varus or valgus; hindfoot height loss; lateral translation of the calcaneal tuberosity and talar tilt or dorsiflexion past neutral \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn cases of malunited calcaneal fractures, the goals of treatment include raising the patient's calcaneal height, mending the talocalcaneal connection, and developing a stable, plantigrade foot. To alleviate symptoms and restore function, corrective calcaneal osteotomy, with or without arthrodesis, is the therapy of choice \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study between our hands was conducted to evaluate calcaneal malunion management through a salvage procedure consisting of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy with malunion type 3 according to Zwipp and Rammelt classification and follow up the outcome of their management.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics approval and Consent:\u003c/h2\u003e \u003cp\u003eThis was a prospective interventional study that was done at the Orthopedic Surgery Department of Al Zahraa University Hospital,(Cairo, Egypt). The study period extended from April 2023 to April 2025, during which patients were consecutively recruited and followed up for at least 12 months postoperatively. The study was approved via the Institutional Review Board of Al-Zahraa University Faculty of Medicine, and it was given the following code: \u003cb\u003e1836/15-3-2023.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical Trial Number\u003c/strong\u003e \u003cp\u003eNot Applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThis study involved 30 male and female patients in the age between 16 and 60 years with unilateral or Bilateral malunited -articular calcaneal fixation of 6 of 6 months or older of injury, subtalar arthritis and deformity\u0026thinsp;\u0026plusmn;\u0026thinsp;Loss of height.\u003c/p\u003e \u003cp\u003ePatients with active infection or bad soft tissue coverage, duration of fractures of less than 6 months, diabetic patients or any neurovascular affection, paralytic limb, ipsilateral knee, contralateral knee, hip or spine problems may affect the outcome, CRPS and suicidal patients were excluded from the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAll patients were subjected to the following preoperative evaluation including f\u003c/b\u003eull history taking mainly the mode of trauma, clinical evaluation through (AOFAS), subjective evaluation through (FAAM) score, preoperative laboratory investigation and radiological evaluation (anteroposterior and lateral weight bearing radiographs and CT scans of the ankle and foot).\u003c/p\u003e \u003cp\u003eThe talar inclination angle, talocalcaneal angle, and talocalcaneal height was assessed in the lateral weight-bearing radiograph, while the heel valgus angle was assessed in the coronal cuts of the CT scan by superimposing the cut taken at the midankle joint and the cut taken at the midposterior subtalar joint; the angle is created by the intersection of the tibial axis and the heel bisector.\u003c/p\u003e \u003cp\u003eThe fracture malunion is classified using the Zwipp and Rammelt classification methods.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical technique\u003c/h3\u003e\n\u003cp\u003eThe operation was done under spinal or general anesthesia. Patients were placed in lateral decubitus on the unaffected side using a thigh tourniquet. Each patient received intravenous antibiotics before surgery.\u003c/p\u003e \u003cp\u003eLateral extensile and sinus tarsi methods were applied. To prevent sural nerve injury, the posterior arm of the incision was inserted between the fibula and Achilles tendon in the lateral extensile approach. The horizontal arm was aligned with the fifth metatarsal base to avoid cutaneous issues. A full-thick flap was created.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure (1): The\u003c/b\u003e lateral extensile approach was opened.\u003c/p\u003e \u003cp\u003eLateral wall exostectomy was performed with an osteotome to clear the fibula tip. An oblique lateral closure calcaneal osteotomy was performed from a superior point anterior to the Achilles tendon to an inferior point anterior to the posterior calcaneal tuberosity. A saw added a parallel limb 1 cm anterior to the other. Both osteotomy limbs joined at the calcaneus medial cortex (severe varus deformity may require lateral translation).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFigure (2)\u003c/strong\u003e \u003cp\u003eLateral wall osteotomy using an osteotome.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eVisualizing the subtalar joint with a lamina spreader. To obtain bleeding surfaces, remaining cartilage and sclerotic subchondral bone of the talar and calcaneal joints were removed. Talus-calcaneus surface congruency was carefully checked. Grafting used cancellous bone from exostectomy and osteotomy wedge.\u003c/p\u003e \u003cp\u003eIn all patients, two 6.5-mm screws fixed the osteotomy and arthrodesis site. Screws were introduced from the posteroinferior calcaneus to the center of the talus to close the wound in layers.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure (3): Two parallel guide wire for the screws.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure (4): Two parallel screws for the fusion.\u003c/p\u003e\n\u003ch3\u003ePostoperative Follow Up:\u003c/h3\u003e\n\u003cp\u003eFor two weeks, a short-leg splint healed soft tissue. After two weeks, sutures were removed and a short-leg circular cast was fitted.\u003c/p\u003e \u003cp\u003eAt 3, 6, and 12 months postoperatively, AOFAS, VAS, and FAAM were reassessed in all patients. Control radiographs were taken on the first day postoperatively, after three and six weeks, and after three and six months.\u003c/p\u003e \u003cp\u003eRadiographs used to assess osteotomy and subtalar joint union. Crossing trabeculae at the fusion site and osteotomy confirmed calcaneal osteotomy-subtalar fusion union.\u003c/p\u003e \u003cp\u003eThe last follow-up at 12 months included weight-bearing anteroposterior and lateral radiographs. Imaging investigations measured valgus angle, talocalcaneal angle, height, and talar inclination angle.\u003c/p\u003e\n\u003ch3\u003eStatistical analysis of data\u003c/h3\u003e\n\u003cp\u003eThe data collected were coded, processed and analyzed with Statistical Package for Social Sciences (SPSS) version 26 for Windows\u0026reg; (IBM, SPSS Inc, Chicago, IL, USA). Qualitative data were shown as number (frequency) and percent. The Kolmogorov-Smirnov test tested quantitative data for normality. Parametric data were shown as median\u0026thinsp;\u0026plusmn;\u0026thinsp;SD while non-parametric data were expressed as median (range).\u003c/p\u003e \u003cp\u003e \u003cb\u003eMann Whitney Test (U test)\u003c/b\u003e was used to assess the statistical significance of the difference between two independent study group with non-parametric data. \u003cb\u003eRepeated measures ANOVA Test\u003c/b\u003e was used to assess the statistical significance of the difference between quantitative variables at different tie points, with paired samples t-test being used as a comparative tool between two time points. The differences were considered statistically significant when the P value was \u0026le;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe current study included 30 cases with malunited intraarticular fracture of the calcaneus. As shown in this table (1), the mean age of the cases was 35.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27 years with a range between 17 and 53 years. There were 22 males (73.3%) and 8 females (26.7%).\u003c/p\u003e \u003cp\u003eThis table also shows that the mean duration from primary fixation till arthrodesis was 29.80\u0026thinsp;\u0026plusmn;\u0026thinsp;30.05 months, with a range between 8 and 132 months. The right side was affected in 13 cases (43.3%), while the left side was affected in 17 cases (56.7%). Varus deformity was shown in 5 cases (16.7%), while valgus deformity was shown in 25 cases (83.3%). There were 11 cases (36.7%) who had one previous operation, 1 case (3.3%) with two previous operations, and 1 case (3.3%) with three previous operations.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(1)\u003c/strong\u003e \u003cp\u003eBasic data in the cases of the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStudy cases\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (Range)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (17\u0026ndash;53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (Range)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from primary fixation till arthrodesis (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.80\u0026thinsp;\u0026plusmn;\u0026thinsp;30.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (8\u0026ndash;132)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeel deformity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVarus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValgus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of previous surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(2) shows that the performed operative techniques were arthrodesis\u0026thinsp;+\u0026thinsp;calcaneal osteotomy in 7 cases (23.3%), calcaneoplasty\u0026thinsp;+\u0026thinsp;arthrodesis in 3 cases (10%), calcaneoplasty\u0026thinsp;+\u0026thinsp;distraction arthrodesis in one case (3.3%), distraction arthrodesis in 18 cases (60%) and subtalar arthrodesis in one case (3.3%). Associated operation (iliac bone graft) was required in 10 cases (33.3%). No intraoperative complications were reported.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(2) also shows that there were 3 cases (10%) who had postoperative complications in the form of infection. No cases required additional operations. This table shows that at 6 months postoperative, all the patients were satisfied.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(2)\u003c/strong\u003e \u003cp\u003eOperative and postoperative data in the cases of the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStudy cases\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative technique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArthrodesis\u0026thinsp;+\u0026thinsp;Calcaneal osteotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcaneoplasty\u0026thinsp;+\u0026thinsp;Arthrodesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcaneoplasty\u0026thinsp;+\u0026thinsp;distraction arthrodesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistraction Arthrodesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtalar arthrodesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociated procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIliac bone graft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient satisfaction (At 6 months postoperative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed for other operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFigure (5)\u003c/strong\u003e \u003cp\u003eOperative technique in the cases of the study\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAs shown in table (3), there was a statistically significant increase in the FAAM Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the FAAM Score at 1 year postoperative as compared to 6 months value.\u003c/p\u003e \u003cp\u003eThere was a statistically significant increase in the AOFAS Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the AOFAS Score at 1 year postoperative as compared to 6 months value.\u003c/p\u003e \u003cp\u003eThere was a statistically significant increase in the Talar declination angle at 6 months and 1 year postoperative as compared to the preoperative value. There was a statistically significant decrease in the Talar declination angle at 6 months and 1 year postoperative as compared to the preoperative value.\u003c/p\u003e \u003cp\u003eThere was a statistically significant increase in the lateral talocalcaneal angle at 6 months and 1 year postoperative as compared to the preoperative value. There was a statistically significant decrease in the lateral talocalcaneal angle at 6 months and 1 year postoperative as compared to the preoperative value.\u003c/p\u003e \u003cp\u003eThere was a statistically significant increase in the talocalcaneal height at 6 months and 1 year postoperative as compared to the preoperative value.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(3)\u003c/strong\u003e \u003cp\u003eFollow up of the different scores at preoperative, 6 months postoperative and 1 year postoperative\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAt 6 months postoperative\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAt 1 year postoperative\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercent of change\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eFAAM Score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e38.71\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(16.8 : 105.26)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;381.142\u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAOFAS Score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.81\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.85\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e41.17\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(9.71 : 66)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;348.613\u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eTalar declination angle (in varus cases)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e23.4\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e23.4\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e-66.67\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(-172.73 : -38.46)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;15.007\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;=\u0026thinsp;0.018*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTalar declination angle (in valgus cases)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e11.11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(7.89 : 28.95)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;7.426\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.039*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLateral talocalcaneal angle (in varus cases)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.80\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.80\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;50\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(-80 : \u0026minus;\u0026thinsp;13.04)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;15.472\u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLateral talocalcaneal angle (in valgus cases)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e16.67\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(7.14 : 26.53)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;9.456\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.020 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.034 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTalocalcaneal height\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e68.10\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003e2.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e68.10\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003e2.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e16.03\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(-10.45 : 30.91)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;32.198\u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eP: probability.\u003c/p\u003e \u003cp\u003eF: Repeated measures ANOVA\u003c/p\u003e \u003cp\u003e*: Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003cp\u003eP1: Significance in relation to preoperative data\u003c/p\u003e \u003cp\u003eP2: Significance in relation to 6 months postoperative\u003c/p\u003e \u003cp\u003eThe following table shows that there was no statistically significant difference between the cases with different age groups regrading FAAM percent of change, AOFAS Percent of change, Talar declination percent of change, Lateral talocalcaneal angle percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(4)\u003c/strong\u003e \u003cp\u003eAnalysis of the percent of change of the tested parameters according to the age groups\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026le;\u0026thinsp;40 years\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026gt;\u0026thinsp;40 years\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAAM percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38.71 (22.73 : 105.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.16 (26.15 : 58.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOFAS Percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41.94 (25.37 : 60.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.71 (32.31 : 66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalar declination percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.81 (-150 : 28.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.11 (-172.73 : 17.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral talocalcaneal angle percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.21 (-76.19 : 26.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.67 (-80 : 18.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalocalcaneal height percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (-10.45 : 30.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.18 (12.7 : 30.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(5) shows that there was no statistically significant difference between the male and female cases regrading FAAM percent of change, AOFAS Percent of change, Talar declination percent of change, Lateral talocalcaneal angle percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(5)\u003c/strong\u003e \u003cp\u003eAnalysis of the percent of change of the tested parameters according to the gender\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAAM percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.68 (25.76 : 105.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.54 (22.73 : 60.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOFAS Percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.69 (25.37 : 60.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.73 (31.75 : 66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalar declination percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.81 (-172.73 : 28.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.49 (-38.46 : 20.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral talocalcaneal angle percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.95 (-80 : 26.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.29 (-28.57 : 18.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalocalcaneal height percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.95 (-10.45 : 30.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.28 (8.33 : 27.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(6) shows that there was no statistically significant difference between the cases with affected right or left sides regrading FAAM percent of change, AOFAS Percent of change, Talar declination percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value. While Lateral talocalcaneal angle percent of change was statistically significantly higher in the left side.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(6)\u003c/strong\u003e \u003cp\u003eAnalysis of the percent of change of the tested parameters according to the affected side\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAAM percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38.67 (29.23 : 76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.71 (22.73 : 105.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOFAS Percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38.33 (30.30 : 60.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.83 (25.37 : 66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalar declination percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.33 (-172.73 : 23.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.11 (-38.46 : 28.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral talocalcaneal angle percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.11 (-80 : 26.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.02 (-28.57 : 24.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.049*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalocalcaneal height percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.54 (8.33 : 29.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (-10.45 : 30.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*: Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(7) shows that there was no statistically significant difference between the cases with varus or valgus deformity regrading FAAM percent of change, AOFAS Percent of change and Talocalcaneal height percent of change at last follow up compared to preoperative value. While Talar declination percent of change and Lateral talocalcaneal angle percent of change were statistically significantly higher in the valgus deformity.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(7)\u003c/strong\u003e \u003cp\u003eAnalysis of the percent of change of the tested parameters according to the Heel deformity\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVarus\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValgus\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAAM percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38.71 (29.03 : 46.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.71 (22.73 : 105.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOFAS Percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41.67 (38.33 : 57.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.71 (25.37 : 66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalar declination percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-66.67 (-172.73 : -38.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.11 (7.89 : 28.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral talocalcaneal angle percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;50 (\u0026minus;\u0026thinsp;80 : \u0026minus;\u0026thinsp;13.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.67 (7.14 : 26.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalocalcaneal height percent of change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.95 (10.53 : 29.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.39 (-10.45 : 30.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*: Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study was conducted to evaluate calcaneal malunion management through a salvage procedure consisting of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy with malunion type 3 according to Zwipp and Rammelt classification and follow up the outcome of their management.\u003c/p\u003e \u003cp\u003eThe current study included 30 cases with malunited intraarticular fracture of the calcaneus who were recruited from the orthopedics department at Al- Zhraa University Hospitals.\u003c/p\u003e \u003cp\u003eIn this study, the mean age of the cases was 35.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27 years with range between 17 and 53 years. There were 22 males (73.3%) and 8 females (26.7%).\u003c/p\u003e \u003cp\u003eThe results agreed with those of Abouelsoud cleared that the mean age was 34.83 (range, 22\u0026ndash;46) years old. There was male predominance as male:female ratio was 19:4 \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis was also in accordance with Mar'ei et al. who included 24 cases with malunited calcaneal fractures and showed that there were 20 male (83.3%) and 4 females (16.7%), the oldest was 58 with a mean of 40.9 years (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3) \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the current study, the mean duration from primary fixation till arthrodesis was 29.80\u0026thinsp;\u0026plusmn;\u0026thinsp;30.05 months with range between 8 and 132 months.\u003c/p\u003e \u003cp\u003eA research by Guan et al. involved 170 patients (184 feet) with a weighted mean age of 37.6 who underwent reconstructive calcaneal operations with/without subtalar arthrodesis at 15.4 months following first injury. The mean follow-up was 42.8 months \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe differences in the interval duration between the studies could be due to variation in the healthcare facilities and protocols of different centers.\u003c/p\u003e \u003cp\u003eIn the current study, the right side was affected in 13 cases (43.3%) while the left side was affected in 17 cases (56.7%). Varus deformity was shown in 5 cases (16.7%) while valgus deformity was shown in 25 cases (83.3%).\u003c/p\u003e \u003cp\u003eZeynalov and Arapova found that varus and valgus deformity were approximately equally distributed in twelve individuals with post-traumatic deformed hindfoots following malunited calcaneal fractures (5/7) \u003csup\u003e([\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis illustrates that both deformities can occur and there is no prevalence of one over the other reported in the literature.\u003c/p\u003e \u003cp\u003eCalcaneal varus, which partly transfers weight-bearing to the lateral side of the foot, can develop from a malunited calcaneal fracture with superior translation of the tuberosity, affecting hindfoot biomechanics. Long-term severe varus hindfoot may cause heel eversion in early stance phase, reducing shock absorption and increasing injury risk \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLateral wall exostosis from unified lateral wall blow-out and superolateral translation causes calcaneal valgus deformity and heel broadening. Calcaneofibular impingement, pseudoarticulation, and peroneal tendinosis can result from exostosis, altering lower limb posture and muscle strength \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe efficacy of surgical procedures can assist doctors tailor treatment to the patient's condition.\u003c/p\u003e \u003cp\u003eWith 29 patients, Agren et al. conducted in situ subtalar arthrodesis. X-ray and CT scans revealed substantial residual abnormalities in afflicted limbs, suggesting in situ subtalar arthrodesis may not be the optimal treatment for severe calcaneal malunion after a 7\u0026ndash;28 year follow-up \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSome academics have incorporated Dwyer osteotomy to treat hindfoot angular deformity following in situ subtalar arthrodesis, although this cannot restore calcaneal height or subtalar joint collapse \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHuang et al. treated calcaneal malunion by calcaneal metatarsal slip osteotomy and subtalar arthrodesis, like our osteotomy. It cannot establish direct and full contact with the cleansed calcaneal articular surface, and it is susceptible to lose length. After the calcaneal malunion, extra-articular osteotomy is harder to restore the subtalar joint's good match due to the fibrous scar tissue between the calcaneocuboid joint and talocalcaneal interosseous. Second, bone grafts are typically needed to cover the subtalar joint area, and their resorption might cause further fusion failures including partial fusion or lack of union \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, arthrodesis plus calcaneus osteotomy was used in seven cases (23.3%), calcaneoplasty plus arthrodesis in three cases (10%), calcaneoplasty plus distraction arthrodesis in one case (3.3%), distraction arthrodesis in eighteen cases (60%), and subtalar arthrodesis in one case (3.3%) within the present investigation. The use of an iliac bone graft was necessary in 10 patients (33.3%).\u003c/p\u003e \u003cp\u003eWe tracked surgery improvement with AOFAS score, but now there is a focus on patient-reported outcome metrics without healthcare provider interpretation \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. As a result, we evaluated the function using FAAM score. Because of how bad the injury is, the AOFAS and FAAM scores are poor.\u003c/p\u003e \u003cp\u003eThere was a statistically significant increase in the FAAM Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the FAAM Score at 1 year postoperative as compared to 6 months value. Also, there was a statistically significant increase in the AOFAS Score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was a statistically significant increase in the AOFAS Score at 1 year postoperative as compared to 6 months value.\u003c/p\u003e \u003cp\u003eAccording to Mar'ei et al., the mean and range of the AOFAS score before and after adjustment was found to be highly considerably improved after correction, from 24.8 (10\u0026ndash;49) to 73.9 (58\u0026ndash;90) \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Our results confirmed these findings.\u003c/p\u003e \u003cp\u003eOur findings align with Wang et al., who reported a significantly higher postoperative American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score (86.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45, t\u0026thinsp;=\u0026thinsp;27.64, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, paired t-test) than pretreatment \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBai et al. also examined medical records and imaging of 11 calcaneus malunion patients who underwent Y-shape osteotomy and subtalar arthrodesis. The post-operative mean AOFAS score enhanced from 34.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53 to 84.18\u0026thinsp;\u0026plusmn;\u0026thinsp;11.59 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the research conducted by Zeynalov and Arapova, it was discovered that there was a substantial improvement in AOFAS, which went from 55.2 before surgery to 78.8 after 24 months \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWoo et al. examined 51 people in 57 calcaneal malunion cases from March 2006 to December 2017. Patients were observed for 22.8 months on average. SDA handled all cases. Data demonstrated that average AOFAS scores at 3, 6, and 12 months after surgery improved statistically over preoperative values \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurther, the average FAAM ADL score increased from 31.4% before surgery to 74.2% afterward, and the average AOFAS score increased from 23.4 before surgery to 69.6% afterward, according to Niazi et al.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEid et al. stated that there was a 94% union rate and a significant improvement in the AOFAS scores in all of their patients when they used the same mending approach \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, Talar declination angle, lateral talocalcaneal angle and talocalcaneal height showed a statistically significant improvement after correction surgery as compared to preoperative value.\u003c/p\u003e \u003cp\u003eHaving the hindfoot varus angled or the foot in dorsiflexion causes the angle to decrease during the malunion. When one bends at the knee or plants one foot forward, the talocalcaneal angle widens \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. So, the opposite occur after correction.\u003c/p\u003e \u003cp\u003eWe agreed with Mar'ei et al., who found that all radiological parameters, including TCA, TDA, CPA, and TCH, increased significantly and statistically postoperatively than preoperatively \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eConsistent with Wang et al., we found that talocalcaneal height (65.15\u0026ndash;72.68 mm), Calcaneus-talus angle (from 34.46\u0026deg; to 39.7\u0026deg;), and B\u0026ouml;hler's angle (from 25.4\u0026deg; to 86.3\u0026deg;) all improved significantly after surgery. A patient had some discomfort following a vigorous 1-hour stroll \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRadiographers Zeynalov and Arapova found a considerable improvement in a number of parameters, including talar tilt, height of calcaneus, Meary's angle, and hindfoot varus/valgus \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBai et al. found that patients' radiographic parameters\u0026mdash;B\u0026ouml;hler angle, pitch angle, calcaneal width, talocalcaneal height, and hindfoot alignment angle\u0026mdash;improved significantly at the last follow-up. No triceps surae contracture, peroneal tendinitis, anterior ankle impingement, or other issues were seen \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the same context, Bai et al. found that patients' B\u0026ouml;hler angle, pitch angle, calcaneal width, talocalcaneal height, and hindfoot alignment angle were much better at the last follow-up than pre-op. Patients had no triceps surae contracture, peroneal tendinitis, anterior ankle impingement, or other issues \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHenning et al. found that subtalar arthrodesis improved talocalcaneal height from pre to after values (p\u0026thinsp;=\u0026thinsp;0.04) \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAfter treating 17 cases of malunited calcaneal fractures of the Stephens Type ⅏ with in situ subtalar arthrodesis, Savva and Saxby found that the average talar inclination angle was only restored to 36% of the normal side \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this study, there were 3 cases (10%) who had postoperative complications in the form of infection. No cases required additional operations.\u003c/p\u003e \u003cp\u003eThree heels (13% of the total) had problems such as infection and nonunion in the research by Kassem et al. One patient sustained damage to the sural nerve, and two heels exhibited residual varus following surgery \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOne incidence of a problem requiring removal of noticeable hardware was reported in the study by Mar'ei et al. One case had a superficial infection and one case had a deep infection; four cases had varus malalignment of more than 5\u0026ordm; relative to the anatomical alignment; one case's symptoms improved after orthotic treatment and shoe modifications, while the other case is still symptomatic. Six cases had delayed wound healing. Four instances were found to have sural nerve damage. Six patients experienced persistent swelling in the lower extremities after surgery. Four patients had mild ankle arthritis, and two individuals had significant calcaneocuboid joint arthritis \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe cumulative incidence of problems was 38% (106/278) in the meta-analysis by Thompson and Roukis. This is despite the fact that complications are reported for all treatments rather than per patient, meaning that many patients had several difficulties. Consequently, one complication occurs for every 2.6 treatments of calcaneal malunion with bone block distraction subtalar arthrodesis. Problems with soft tissues or bones could be either minor or substantial. There were 45 occurrences of minor soft tissue troubles (16.2%) and 37 cases of light bone difficulties (13.3%). Brief paresthesia and non-surgical superficial infections of soft tissues were identified as instances of mild soft tissue issues. Removing hardware and modifying or removing the shoe gear were necessary procedures for lateral calcaneal wall exostosis, one of the minor bone issues. In all, 278 procedures had six serious problems with soft tissues (2.2%) and eighteen with bones (6.5%) \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe systematic analysis conducted by Schepers revealed that 106 issues, or 38% of the 278 operations examined, were encountered. Of those, 82 were deemed moderate issues, while 24 were deemed significant \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis reflects that correction of malunion calcaneal fractures are relatively safe with low rate of complications.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDue to fracture pattern complexity and soft tissue envelope limitations, orthopedic surgeons will continue to struggle with calcaneal fracture therapy. Correction of malunited calcaneal fractures using subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy improves outcomes without substantial problems.\u003c/p\u003e \u003cp\u003eThere is no international consensus on surgical anatomic reduction and fixation, although trends suggest it is the best way to improve patient satisfaction and reduce post-traumatic osteoarthritis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e \u003cp\u003eThe study was approved via the Institutional Review Board of Al-Zahraa University Faculty of Medicine, and it was given the following code: \u003cb\u003e1836/15-3-2023.\u003c/b\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003e All participants provided written informed consent for publication.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eNo benefits in any form have been received or will be received related directly to this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMoha Elsafty Agree to be accountable for all aspects of the work in ensuringthat questions related to the accuracy or integrity of any part of the work are investigated and resolved, Wael Shaban Approved the version to be published , Moha Abd Ella Had the idea for the article , Moha Abd Elfattah Drafted the work and prepared the figures.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003ewe would like to thank Dr.Awab Ali for his contribution to the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChotikkakamthorn N, Chanajit A, Tharmviboonsri T, Chuckpaiwong B, Harnroongroj T. Minimal invasive surgery in the management of intra-articular calcaneal fractures: A retrospective comparison of screw fixation alone versus screw with small locking plate fixation techniques. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuan X, Xiang D, Hu Y, Jiang G, Yu B, Wang B. Malunited calcaneal fracture: the role and technique of osteotomy\u0026mdash;a systematic review. Int Orthop. 2021;45:2663\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiannini S, Cadossi M, Mosca M, Tedesco G, Sambri A, Terrando S, et al. Minimally-invasive treatment of calcaneal fractures: A review of the literature and our experience. Injury. 2016;47:S138\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai W, Zhu Y, Xu J, Liang J, Lu J. Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res. 2022;17(1):526.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRammelt S, Marx C. Managing severely malunited calcaneal fractures and fracture-dislocations. Foot Ankle Clin. 2020;25(2):239\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStephens HM, Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int. 1996;17(7):395\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbou Elsoud AA, Salama AM, Al Adawy AM. Limited Invasive Techniques in Management of Sander's Type II, III Calcaneal Fractures. Egypt J Hosp Med. 2021;85(2):3561\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMar'ei MM, Attia ME, Salama Shaaban AM, Elgawhary SA. Distraction Subtalar Arthrodesis after Malunited Calcaneal Fractures. Zagazig Univ Med J. 2025;31(2):575\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeynalov V, Arapova I. Calcaneal Malunions Management and Types of Surgical Correction. Foot Ankle Orthop. 2022;7(4):2473011421S01015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanerjee R, Saltzman C, Anderson RB, Nickisch F. Management of calcaneal malunion. JAAOS-Journal Am Acad Orthop Surg. 2011;19(1):27\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu G-R, Yu X. Surgical Management of Calcaneal Malunion. J Orthop Trauma Rehabilitation. 2013;17(1):2\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Aring;gren P-H, Tullberg T, Mukka S, Wretenberg P, Sayed-Noor AS. Post-traumatic in situ fusion after calcaneal fractures: a retrospective study with 7\u0026ndash;28 years follow-up. Foot Ankle Surg. 2015;21(1):56\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKetz J, Clare M, Sanders R. Corrective osteotomies for malunited extra-articular calcaneal fractures. Foot Ankle Clin. 2016;21(1):135\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang P-J, Fu Y-C, Cheng Y-M, Lin S-Y. Subtalar arthrodesis for late sequelae of calcaneal fractures: fusion in situ versus fusion with sliding corrective osteotomy. Foot Ankle Int. 1999;20(3):166\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitaoka HB, Meeker JE, Phisitkul P, Adams SB Jr, Kaplan JR, Wagner E. AOFAS position statement regarding patient-reported outcome measures. Foot Ankle Int. 2018;39(12):1389\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang B, Guan X, Hu Y, Jiang G, Lin Q, Ye J, et al. Multiple reconstructive osteotomy treating malunited calcaneal fractures without subtalar joint fusion. Orthop Surg. 2023;15(3):810\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoo SH, Goh T-S, Ahn T-Y, You JS, Bae S-Y, Chung H-J. Subtalar distraction arthrodesis for calcaneal malunion-comparison of structural freeze-dried versus autologous iliac bone graft. Injury. 2021;52(4):1048\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiazi NS, Aljawadi A, Pillai A. Shaped titanium wedges for subtalar distraction arthrodesis: Early clinical and radiological results. Foot. 2020;42:101647.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEid MAM, El-Soud MA, Mahran MA, El-Hussieni TF. Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft. Strategies trauma limb reconstruction. 2010;5:39\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAly T. Management of valgus extra-articular calcaneus fracture malunions with a lateral opening wedge osteotomy. J foot ankle Surg. 2011;50(6):703\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSundararajan SR, Ramakanth R, Shreeram V, Joseph JB, Rajasekaran S. Is distraction bone block Arthrodesis better than subtalar arthrodesis for malunited calcaneal fractures with subtalar arthritis? A retrospective case series. J Foot Ankle Surg (Asia Pacific). 2021;8(1):3\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenning C, Poglia G, Leie MA, Galia CR. Comparative study of subtalar arthrodesis after calcaneal frature malunion with autologous bone graft or freeze-dried xenograft. J Experimental Orthop. 2015;2:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavva N, Saxby TS. In situ arthrodesis with lateral-wall ostectomy for the sequelae of fracture of the os calcis. J Bone Joint Surg Br Volume. 2007;89(7):919\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKassem MS, Elgeidi A, Badran M, Farag F. Sagittal Resection Osteotomy With Bone Block Distraction Subtalar Fusion for Treatment of Malunited Calcaneal Fractures. J Foot Ankle Surg. 2019;58(4):739\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson MJ, Roukis TS. Management of Calcaneal Fracture Malunion with Bone Block Distraction Arthrodesis: A Systematic Review and Meta-Analysis. Clin Podiatr Med Surg. 2018;36(2):307\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchepers T. The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: a systematic review. Foot. 2013;23(1):39\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Calcaneal malunion, subtalar arthritis, Heel valgus, subtalar arthrodesis","lastPublishedDoi":"10.21203/rs.3.rs-8636186/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8636186/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eto evaluate calcaneal malunion management through a salvage procedure consisting of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy with malunion type 3 according to Zwipp and Rammelt classification and follow up the outcome of their management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e30 patients with complex intra-articular calcaneal malunion to assess the outcome of their management according to the deformity with subtalar deformity with or without calcaneal osteotomy after approval by the local ethical committee of the university.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant increase in the AOFAS score and FAAM score at 6 months and 1 year postoperative as compared to the preoperative value. Also, there was an increase in talocalcaneal height and a change in talar declination and lateral talocalcaneal angle at 6 months and 1 year postoperative.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe\u003c/strong\u003e use of combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy in correcting the malunited calcaneal fractures is associated with significant improvement without the occurrence of major complications.\u003c/p\u003e","manuscriptTitle":"Management of Malunited Intra articular Fracture of the Calcaneous","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 16:21:38","doi":"10.21203/rs.3.rs-8636186/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e539c530-54c0-4518-ae1d-6009a9efc08a","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T04:10:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 16:21:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8636186","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8636186","identity":"rs-8636186","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}