Crushplasty and Media Displacement Calcaneal Osteotomy (MDCO)
Medial Displacement Calcaneal Osteotomy (MDCO) is a workhorse used in hindfoot mechanical realignment. Following MDCO, the formation of a bone step off laterally is inevitable and is more pronounced with a greater the degree of displacement.
Concern that the lateral step-off is a source of pain from compression of the sural nerve and overlying soft tissue has been expressed; however, no previous study had assessed lateral step-off pain as a complication after MDCO, or its true incidence.
Crushplasty, using a bone impactor and mallet with and without a ronguer, has been described as a method to decrease lateral prominence pain by recontouring the step-off following osteotomy fixation. The goal of the method is to create a smoother lateral wall without having to compromise on medial displacement.
“Incidence of Lateral Prominence Pain Following Open Medial Displacement Calcaneal Osteotomy and the Efficacy of Crushplasty as a Preventive Technique” by Kim et al. is a retrospective study of 137 patients (148 feet). It compared patients who underwent MDCO with and without crushplasty to assess the incidence of persistent lateral prominent pain lasting 12 months or greater, and possible risks for postoperative lateral prominence pain.
Incidence of lateral pain was 3.4% in crushplasty group versus 18% in the non-crushplasty group; highlighting persistent lateral pain as a considerable complication after MDCO and the utility of the crushplasty technique in reducing the incidence postoperatively.
The degree of medial displacement was an independent risk factor for lateral prominence pain, suggesting larger medial shifts may necessitate the crushplasty method as a simple, fast, and effective technique to reduce a common postoperative complication.