From the Guidelines
Surgical intervention is not justified solely based on a calcaneal inclination angle of 6 degrees, and treatment decisions should prioritize the patient's symptoms and response to conservative management. The normal range for the calcaneal inclination angle is typically between 18-30 degrees, and an angle of 6 degrees indicates a flatfoot deformity with decreased arch height 1. However, the decision for surgery should be based primarily on the patient's symptoms, functional limitations, and failure of conservative treatments rather than solely on radiographic measurements.
Key Considerations
- Conservative management should be attempted first, including custom orthotic devices, supportive footwear, physical therapy, anti-inflammatory medications, and activity modifications.
- If these measures fail to provide adequate relief after 6-12 months and the patient experiences persistent pain, difficulty walking, or progressive deformity, surgical intervention may be warranted.
- The specific surgical procedure would depend on the patient's age, overall foot alignment, joint flexibility, and associated deformities, as outlined in guidelines such as those from the American College of Foot and Ankle Surgeons 1.
Treatment Approach
- Initial treatment options may include open-backed shoes, orthoses, accommodative padding, NSAID therapy, corticosteroid injections, weight loss (if indicated), and physical therapy 1.
- If symptoms do not improve within six to eight weeks, other diagnoses may need to be considered, and patients should be referred to a podiatric foot and ankle surgeon for further evaluation and potential surgical intervention 1.
- The low calcaneal inclination angle reflects altered biomechanics that can lead to increased stress on surrounding structures, potentially causing pain and dysfunction in the foot and ankle as well as the knees, hips, and lower back.
From the Research
Calcaneal Inclination Angle and Surgical Intervention
- The calcaneal inclination angle is a significant factor in assessing the need for surgical intervention in patients with insertional Achilles tendinopathy or other foot-related conditions.
- A study published in 2020 2 found that a dorsal wedge calcaneal osteotomy can be an effective treatment for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle.
- However, the study does not provide a specific threshold for the calcaneal inclination angle that would justify surgical intervention.
Comparison of Calcaneal Inclination Angles
- A study from 2012 3 compared the calcaneal inclination angles of patients with insertional Achilles tendinosis and matched controls, finding a statistically significant difference (20.9 vs. 18.9 degrees), but the difference was not considered clinically significant.
- The study from 2020 2 does not provide a direct comparison of calcaneal inclination angles, but it suggests that a high calcaneal inclination angle may be an indication for surgical intervention.
Surgical Intervention for Calcaneal Fractures
- Studies have investigated the treatment of calcaneal fractures, including operative and nonoperative management 4, 5.
- However, these studies do not provide specific guidance on the calcaneal inclination angle as an indication for surgical intervention.
Measurement of Calcaneal Varus Angle
- A study from 1992 6 measured the calcaneal varus angle in normal and fractured feet using CT scans, but it does not provide information on the calcaneal inclination angle or its relation to surgical intervention.
Conclusion on Calcaneal Inclination Angle of 6 Degrees
- Based on the available evidence, there is no clear indication that a calcaneal inclination angle of 6 degrees would justify surgical intervention.
- The studies provide limited information on the specific threshold for surgical intervention, and more research is needed to determine the relationship between the calcaneal inclination angle and the need for surgery.