Biomechanical comparison in a cadaveric flatfoot model between different calcaneal osteotomies with and without transfer from the peroneus brevis to the longus

Introduction: Progressive collapsing flexible foot deformities are generally treated with joint-preserving techniques. Our objective was to evaluate biomechanically the effect of different calcaneal osteotomies with or without a peroneus brevis to longus transfer (PBtoPL) on a cadaveric flatfoot model. Methods: 15 cadaveric foot and ankle specimens were used in a mid-stance phase of gait model. Evans, medial displacement, Double, Z (step cut), and IZ (inverted Z) osteotomies were compared. A Vicon positioning system was used to measure angular changes. Results: Evans and Double osteotomies generated the highest adduction effect; Z and IZ osteotomies generated 50 % less. Evans, Double and IZ osteotomies created a significant supination effect. The PBtoPL transfer produced non-significant changes. Conclusions: Evans and Double osteotomies were the most potent calcaneal osteotomies. Evans, Double, and IZ osteotomies had a similar supination effect. Further studies are needed to explore the role of the PBtoPL tendon transfer in greater detail.