Neurovascular and Clinical Outcomes of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy (PECO) Technique to Correct Hindfoot Malalignment

Foot Ankle Int. 2019 Feb;40(2):178-184. doi: 10.1177/1071100718800983. Epub 2018 Oct 11.


Background:: Standard open calcaneal osteotomies to correct hindfoot malalignment have been associated with high complication rates, including nerve damage and wound infection. This has resulted in the development of minimally invasive techniques such as the percutaneous endoscopically assisted calcaneal osteotomy (PECO), which in cadaver studies has been shown to be potentially safer than open surgeries. The aim of this study was to demonstrate the safety and effectiveness of PECO in a clinical setting, with regard to neurovascular injury rates, infection, and short-term radiographic and functional outcomes.

Methods:: Forty-one (41) patients with planovalgus or cavovarus foot deformities underwent treatment using PECO. Outcomes were analyzed at 6 months and primarily included neurovascular outcomes and wound infection rates. Secondarily, radiographic and functional (visual analog scale for pain [VAS], 36-Item Short Form Medical Outcomes Survey [SF-36], and Foot Function Index [FFI] scores) outcomes were also assessed.

Results:: There were no reported cases of superficial wound infections, lateral calcaneal or sural nerve dysesthesia. Minor complications occurred in 6/41 feet. The mean postoperative hindfoot correction was 8.3 ± 2.2 mm (range: 6-15mm) compared to preoperative status. Compared to preoperative status, significant improvements ( P = .001 for all) were seen in the VAS, SF-36, and FFI at 6 months postoperatively.

Conclusions:: PECO resulted in minimal complications with no lateral calcaneal or sural nerve dysesthesias and no wound complications. It also resulted in significant improvements in postoperative radiographic and functional outcomes from baseline to 6-months postoperatively, demonstrating its use as a safe and effective means of treating hindfoot malalignment.

Level of evidence:: Level IV, retrospective case series.

Keywords: calcaneal osteotomies; hindfoot malalignment; lateral calcaneal nerve (LCN); open surgery; percutaneous endoscopically assisted calcaneal osteotomy (PECO).

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Calcaneus / physiopathology
  • Calcaneus / surgery*
  • Endoscopy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteotomy / methods*
  • Peripheral Nerve Injuries / prevention & control*
  • Postoperative Complications / prevention & control*
  • Radiography
  • Retrospective Studies
  • Surveys and Questionnaires
  • Talipes Cavus / physiopathology
  • Talipes Cavus / surgery*
  • Young Adult