28300 Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

Name of the Procedure:

Osteotomy; calcaneus (e.g., Dwyer or Chambers type procedure), with or without internal fixation.

Summary

An osteotomy of the calcaneus is a surgical procedure where the heel bone (calcaneus) is cut and repositioned to correct deformities or improve function. This procedure can include the use of screws, plates, or other hardware to fix the bone in the new position.

Purpose

Medical Condition or Problem Addressed:

The calcaneus osteotomy is primarily performed to correct deformities such as flatfoot (pes planus), high arch (pes cavus), or to address chronic pain and instability in the heel.

Goals or Expected Outcomes:

The aims are to restore normal alignment and function of the foot, relieve pain, and improve the patient’s ability to walk and stand comfortably.

Indications

• Severe foot deformities such as flatfoot or high arch.
• Chronic heel pain not responsive to conservative treatments (e.g., orthotics, physical therapy).
• Instability or dysfunction in the heel area that affects walking or standing.

Preparation

• Patients may need to fast (no food or drink) for at least 8 hours before the procedure.
• Medication adjustments, particularly blood thinners, may be necessary.
• Preoperative assessments such as X-rays or MRI scans to plan the surgery.
• Discussion with the surgeon about the procedure and consent form signing.

Procedure Description

1. Anesthesia: General or regional anesthesia will be administered.
2. Incision: An incision is made on the side of the heel.
3. Bone Cutting: The calcaneus bone is precisely cut.
4. Repositioning: The bone segments are repositioned to correct the deformity.
5. Fixation: Screws, plates, or other fixation devices may be used to hold the bone in its new position.
6. Closure: The incision is closed with stitches or staples.

Tools and Equipment:

• Surgical saws and chisels for bone cutting.
• Screws, plates, or other hardware for internal fixation.

Duration

The procedure typically takes approximately 1 to 2 hours.

Setting

This surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Common Risks: Infection, bleeding, swelling.
• Rare Risks: Nerve damage, nonunion or delayed union of the bone, blood clots, and hardware discomfort or failure.

Benefits

• Relief from chronic pain.
• Improved foot alignment and function.
• Enhanced ability to walk and stand.

Realization Time:

Many patients start to notice improvements in pain and function within a few weeks to a few months after surgery.

Recovery

• Post-procedure Care: Elevation of the foot, wound care, and wearing a cast or boot.
• Expected Recovery Time: Full recovery may take 3 to 6 months, including physical therapy.
• Restrictions: Limited weight-bearing on the operated foot for several weeks, use of crutches or a walker.
• Follow-up: Periodic check-ups to monitor healing and remove stitches or hardware if necessary.

Alternatives

• Non-Surgical: Orthotic devices, physical therapy, and pain management.
• Surgical: Other types of foot surgery depending on the specific deformity, like tendon transfers or joint fusions.

Pros and Cons:

• Non-surgical options involve less risk and no recovery time but may not be as effective.
• Other surgical options may have different risks and benefits based on individual cases.

Patient Experience

• During Procedure: Anesthesia ensures the patient feels no pain during surgery.
• After Procedure: Initial pain managed with medications, use of crutches or a walker. Some discomfort and swelling are expected. Physical therapy may be required for optimal recovery and function restoration.