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Calcaneal Osteotomy – Procedure, Techniques & Recovery

A calcaneal osteotomy is a surgical procedure on the heel bone to correct foot deformities. It is commonly used for flatfoot or cavus foot conditions.

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A calcaneal osteotomy is a surgical procedure on the heel bone to correct foot deformities. It is commonly used for flatfoot or cavus foot conditions.

What is a Calcaneal Osteotomy?

A calcaneal osteotomy (also called a calcaneus osteotomy or heel bone osteotomy) is a surgical procedure in which the calcaneus – the largest bone of the foot, commonly known as the heel bone – is cut and repositioned to correct an abnormal alignment. The primary goals are to restore normal foot biomechanics, relieve pain, and prevent secondary damage to joints, ligaments, and tendons.

Indications

A calcaneal osteotomy is indicated when conservative treatments such as orthotics, physical therapy, or bracing have failed to provide sufficient relief. Common indications include:

Pes planovalgus (flatfoot / planovalgus deformity): collapse of the medial arch with outward tilting of the heel bone
Pes cavus (high-arched foot): excessive elevation of the foot arch with inward tilting of the heel
Posterior tibial tendon dysfunction (PTTD): weakening of the posterior tibial tendon leading to progressive flatfoot deformity
Post-traumatic malalignment following calcaneal fractures
Achilles tendon pathology secondary to heel misalignment

Surgical Techniques

Several osteotomy techniques exist, selected based on the type and severity of the deformity:

Medializing Calcaneal Osteotomy

The heel bone is cut transversely and the posterior fragment (tuber calcanei) is shifted inward (medially). This corrects a valgus deformity (outward tilting of the heel) and is the most common technique used in adult flatfoot reconstruction.

Lateralizing Calcaneal Osteotomy

The calcaneus is shifted outward (laterally) to correct a varus deformity (inward tilting of the heel), typically seen in high-arched foot conditions.

Evans Osteotomy (Lateral Column Lengthening)

A bone graft is inserted into an osteotomy of the anterior calcaneus to lengthen the lateral column of the foot and restore the medial arch. This technique is frequently used in flexible flatfoot deformities.

Z-Osteotomy and Combined Techniques

In complex cases, Z-shaped cuts or combinations of multiple osteotomies may be used to achieve multi-dimensional correction of the heel alignment.

Surgical Procedure

The operation is typically performed under general or spinal anesthesia. The surgeon makes an incision on the lateral or posterior aspect of the heel, cuts the bone using an oscillating saw, and fixes the corrected position with titanium screws, staples, or plates, or in some cases with absorbable implants. Additional procedures on tendons, ligaments, or adjacent bones are often performed simultaneously to achieve a complete correction.

Postoperative Care and Rehabilitation

Recovery following a calcaneal osteotomy is structured and progressive:

Immobilization: The foot is initially placed in a cast or boot for several weeks to protect the osteotomy site.
Partial weight-bearing: Gradual weight-bearing typically begins after approximately 6–8 weeks, guided by radiographic evidence of bone healing.
Physical therapy: Targeted exercises to strengthen foot muscles, restore range of motion, and retrain gait are essential for full recovery.
Full weight-bearing: Most patients achieve full weight-bearing capacity within 3–6 months after surgery.

Risks and Complications

As with any surgical procedure, potential risks should be discussed thoroughly before the operation:

Wound or bone infection
Nerve or vascular injury (particularly the sural nerve)
Delayed bone healing or non-union (failure of the bone to heal)
Loss of correction or recurrent deformity
Pain related to hardware (screws or plates)
Deep vein thrombosis or pulmonary embolism

Outcomes and Prognosis

With careful patient selection and proper surgical technique, calcaneal osteotomy generally yields excellent results. The majority of patients report significant pain reduction and improved walking ability. Long-term studies indicate that restoring proper heel alignment can slow or prevent the progression of joint degeneration (osteoarthritis) in the hindfoot and ankle.

References

Myerson MS: Reconstructive Foot and Ankle Surgery. Elsevier Saunders, Philadelphia, 2005.
Toolan BC: Current Concepts Review – The Treatment of Failed Reconstruction for Adult Acquired Flatfoot Deformity. Foot & Ankle International, 2003; 24(5): 417–424.
Wapner KL, Myerson MS: Principles of Calcaneal Osteotomy. In: Foot and Ankle Clinics of North America, 2003; 8(3): 507–522.

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