Jonathan Deland, M.D. and Scott Ellis, M.D., orthopedic foot and ankle surgeons at Hospital for Special Surgery (HSS), were recently honored at the annual meeting of the American Orthopaedic Foot and Ankle Society (AOFAS). Drs. Deland and Ellis received the prestigious J. Leonard Goldner Award, a recognition that highlights the most outstanding research paper presented at the AOFAS annual meeting. According to the October 28, 2014 news release, “The researchers found that the best results after a flatfoot reconstruction were achieved in patients whose foot was not corrected too much with a procedure called ‘lateral column lengthening.’”
Jonathan Deland, M.D., Scott Ellis, M.D. Receive J. Leonard Goldner Award
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“In this procedure, a bone graft of various sizes can be placed in the side of the foot to shift the flatfoot. Patient outcomes were measured by the Foot and Ankle Outcome Score, which was validated in a previous HSS study for patients with flatfoot. This information may help guide surgeons at the time of flatfoot surgery, according to Dr. Ellis and Dr. Deland.”
Dr. Ellis told OTW, “The most interesting aspect for me was that we found that worse outcomes correlated directly with the x-ray parameters of over-correcting the foot. This recognition means that we can help improve outcomes after the surgery by paying strict attention to how much correction we perform.”
Dr. Deland commented to OTW, “This study shows how to minimize the chance of a classic problem with correcting a severely collapsed foot, that of lateral overload. The severely collapsed foot is usually from posterior tibial tendon insufficiency, a not uncommon condition. In a severe flatfoot, when a lateral column lengthening (lengthening a bone on the outside of the foot) is necessary, this study shows how to minimize the chance of lateral overload. Lateral overload puts too much weight on the lateral side of the foot and causes lateral discomfort or pain. This has been a significant problem and is not so easy to avoid.”
“The meaning of this award for us is that the AOFAS recognizes the importance of our work and, just as significantly, recognizes the value of good research.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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