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Lateral Decompression for Malunited Os Calcis Fractures

Nineteen heels in 19 patients underwent a lateral decompression for hindfoot pain secondary to a malunited os calcis fracture with subtalar intra-articular involvement. The operative procedure consisted of a lateral calcaneal bony prominence removal (ostectomy) and sural nerve release or transection. In addition, the peroneal tendons were released, relocated, and lengthened as necessary, with repair or reconstuction of their retinaculum. Eight patients (group I) had previously undergone a late subtalar fusion without relief of lateral symptoms. Eleven patients (group II) underwent a lateral decompression as an alternative to late subtalar fusion. In both groups combined, there were 14 males and 5 females with an average age of 40 years. The average follow-up was 28 months in group I and 17 months in group II. A satisfactory result was obtained in 75% (6 of 8) of the patients in group I and in 82% (9 of 11) of the patients in group II. This compares to a published success rate of approximately 50% in selected series in the literature and the authors' similar success rate of 46% for late subtalar fusion for the same pathology. The results suggest that the lateral decompression procedure offers a technically simpler yet effective alternative to late subtalar fusion for lateral pain following a malunited os calcis fracture with subtalar intra-articular involvement.