Post-Traumatic Tibio-Fibular Malunion with Hindfoot Valgus: Treatment with Calcaneal Medializing and Fibular Lengthening Osteotomies – A Case Report

Introduction: Post-traumatic fibular shortening results in malrotation and lateral talar tilt, disrupting joint congruence and increasing stress. These malunited ankle fractures lead to complications such as chronic pain, reduced mobility, and post-traumatic osteoarthritis. The impact of these malunions highlights the importance of anatomical reconstruction to restore biomechanical balance and prevent complications. This case study provides a detailed insight into the management of complex post-traumatic ankle deformities, highlighting the success of joint-preserving osteotomies and their potential to delay more invasive interventions. Case Report: This case report illustrates the restoration of joint congruence in a patient presenting with chronic lateral-dorsal pain, limited mobility, and impingement symptoms of the ankle. The valgus deformity of the hindfoot and post-traumatic misaligned tibio-talar osteoarthritis were addressed through fibular Z-lengthening osteotomy with corticocancellous grafting and medializing calcaneal osteotomy. Conclusion: This case underscores the importance of an early recognition and targeted surgical approach to correct complex post-traumatic deformities. Joint reconstruction, restoring the ankle mortise’s balance, has clinical benefits by reducing pain, improving ankle function, and preventing the development or progression of mechanical joint degeneration. Keywords: Hindfoot valgus, valgus ankle osteoarthritis, supramalleolar fibular lengthening osteotomy, medializing calcaneal osteotomy, realignment surgery.

Abstract licence: CC BY-NC

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