cpt code for lateral column lengthening

The https:// ensures that you are connecting to the In cases with more than a little increased heel valgus, it is normally necessary to do a posterior calcaneal osteotomy as well as an LCL to obtain correct position of the heel. Usually will have pain over the PTT. At the 10-16 week mark, the patient can then transition into a shoe. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) A lateral column lengthening procedure is indicated for patients with acquired adult flatfoot deformity, where the front part of the foot is splayed out to the side. Please enable it to take advantage of the complete set of features! Radiographically, the abduction should be corrected so that there is a normal amount of uncoverage of the talar head (30% or less), and no adduction of the talonavicular joint. The bone graft is a trapezoidal bone piece and can be either taken from the top aspect of the pelvis (iliac crest) or, in some instances, from a cadaver. After lateral column lengthening with calcaneocuboid fusion, 48% of talonavicular and 70% of subtalar joint range of motion were preserved. official website and that any information you provide is encrypted For the next 4-6 weeks (assuming the bone graft has healed), the patient can weight bear as tolerated in a cast boot. I'm new to foot surgeries so this was helpful. One way of performing this procedure is by cutting the bone (osteotomy) through the front part of the calcaneus. 26.4). Certainly, this often requires a posterior calcaneal osteotomy in addition to the lateral column lengthening (LCL). 2010 Jul-Aug;49(4):380-4. doi: 10.1053/j.jfas.2010.04.023. Boot or hinged anklefoot orthosis (AFO) brace. Foot Ankle Clin. Such a patient most often preoperatively does not have subfibular impingement but can certainly have subtalar impingement. 2012 Jun;17(2):309-22. doi: 10.1016/j.fcl.2012.03.008. the CPT codes tracked to each defined case category. 2017;2017:4383981. doi: 10.1155/2017/4383981. Consensus statement one: Lateral column lengthening (LCL) procedure is recommended when the amount of talonavicular joint uncoverage is above 40%. How do you code an Evans procedure - cuboid osteotomy? Dissect at the midportion of the incision to find the floor of the sinus tarsi, taking care to avoid and stay above the peroneal tendons and sural nerve. If, on a simulated AP weight-bearing view with the eversion stress, there is adduction at the talonavicular joint or there is almost no eversion in the hindfoot, the foot is overcorrected. San Francisco CA 94123. Please advise on how to code this service. A lateral column lengthening, also called a calcaneal lengthening or Evans osteotomy, helps improve the positioning of the foot. Special hardware holds the graft and the bone together so they can grow together to form one bone. Fig. A lateral column lengthening is performed typically to correct the forefoot abduction aspect of the deformity. The guiding principle behind the lateral column lengthening is to bring the forefoot and midfoot out of abduction while using the foot's natural bony architecture to drive the hindfoot into inversion and dorsiflexion. Management of the rigid arthritic flatfoot in adults: triple arthrodesis. If available, obtain a standing computed tomography (CT) scan in cases of severe deformity. The CPT codes available in each . Orthopedic foot and ankle surgeons may perform a lateral column lengthening if the patient suffers from a flat foot or foot that rotates outward. Few options exist for the treatment of revision and severe cases of end-stage flatfoot deformity. Epub 2017 Apr 10. Same Also, on the coronal views of the CT scan, look for lateral subluxation of the subtalar joint, which probably indicates the need for a subtalar fusion. You may also needEvans Lateral Column Lengthening and Cotton OsteotomyTriple ArthrodesisTriple ArthrodesisFlexor Digitorum Longus Transfer for Posterior Tibial Tendon DysfunctionFlexor Digitorum Longus Transfer for Posterior Tibial Tendon DysfunctionNaviculocuneiform Fusion to Treat Midfoot Arthritis and DeformityNaviculocuneiform Fusion to Treat Midfoot Arthritis and DeformityCavovarus Reconstruction If this is your first visit, be sure to check out the. Weight-bearing anteroposterior (AP), lateral and Saltzmans view radiographs are performed to assess degree of planovalgus. Correct alignment so that each of the following is achieved: Moderate to severe osteoporosis. Take note of the shape of the opening, and replicate the shape. 26.1 ). Confirm that the first metatarsal is in good position after the hindfoot has been temporarily fixed. HSS J. Lateral column lengthening is a powerful procedure performed either with an Evans calcaneal osteotomy or calcaneocuboid distraction arthrodesis that can be used as an adjunct in realigning the flatfoot. Place a K-wire 17 mm from the calcaneocuboid joint through the lateral cortex and into the medial cortex one-third the way down from the dorsal rim aiming in between the middle and posterior facets (Fig. Autograft and allograft unite similarly in lateral column lengthening for adult acquired flatfoot deformity. The surgeon removes the chosen hardware after 3-4 weeks of healing. Eur J Orthop Surg Traumatol. Before A lateral column lengthening procedure is indicated for patients with acquired adult flatfoot deformity, where the front part of the foot is splayed out to the side. There are two general ways of doing a lateral column lengthening, both of which involve taking a bone graft and inserting it into the lateral column. Assess a standing AP view of the ankle to confirm no valgus of the talus in the ankle joint. Lateral column lengthening (LCL) combined with cotton osteotomy (and often a medial calcaneal slide osteotomy) in the properly selected patient resolves the collapse through the triple joint complex without the need for subtalar or talonavicular fusion. 26.1.4 Contraindications government site. Dissect laterally over the anterior calcaneus, from a point adjacent to the calcaneocuboid joint to the level of the posterior facet. My biggest New to podiatry coding (25 year+ Ortho background) struggling with (among other things! Careers. 26.5 Preoperative Preparation and Patient Positioning Federal government websites often end in .gov or .mil. Too much correction can result in a good-looking X-ray and no impingement, but the hindfoot still too stiff. If this tendon becomes inflamed, overstretched, or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot. The Relief Institute does not furnish or render professional health care services or medical care. Lateral column lengthening is a useful adjunct to hindfoot arthrodesis in the correction of revision and severe end-stage flatfoot deformity. Indication for this procedure is excessive eversion/abduction of the midfoot with collapse of the arch as evidenced by one of the following: ): Keywords: This should be explained to the patient. View any code changes for 2023 as well as historical information on code creation and revision. The surfaces were osteotomized to expose cancellous bone and remove the surfaces. For the patients who underwent a lateral column lengthening procedure, we found a significant improvement in calcaneal inclination angle (p = .001) and greater correction in talar declination angle, cuboid abduction angle, and talocalcaneal angle when compared with the control group. PMC Borderline X-ray findings of one or two, but the patient has excessive pronation (eversion and abduction) seen clinically by a severe flatfoot with sag in the arch just distal to the ankle but not at the level of the tarsometatarsal or naviculocuneiform joints. Both products are available in several shapes and sizes, allowing surgeons to choose between a permanent structural implant or an allograft implant. I am in between codes 27685 vs. 28200. The bone graft is inserted in the joint,which serves as a joint fusion while also lengthening the lateral column. The bone graft is inserted in the joint, which serves as a joint fusion while also lengthening the lateral column. The site is secure. Right triple arthrodesis Read a CPT Assistant article by subscribing to. Alternative fixation is with a lateral low-profile claw-type plate to provide compression. 2014 Sep;117(9):785-90. doi: 10.1007/s00113-014-2603-6. View the CPT code's corresponding procedural code and DRG. 2010 Jul-Aug;49(4):380-4. doi: 10.1053/j.jfas.2010.04.023. Before Hix J, Kim C, Mendicino RW, Saltrick K, Catanzariti AR. Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model. J Foot Ankle Surg. Bethesda, MD 20894, Web Policies Triple arthrodesis or medial-approach double arthrodesis have been the standard but often do not provide enough correction of the deformity. Alternative fixation is with a lateral low-profile claw-type plate to provide compression. Search across Medicare Manuals, Transmittals, and more. Measure the depth of the K-wire when it has reached the medial cortex. eCollection 2022 Oct. Smyth NA, Aiyer AA, Kaplan JR, Carmody CA, Kadakia AR. Sands A, Early J, Harrington RM, Tencer AF, Ching RP, Sangeorzan BJ. 2011 Jul;29(7):1047-54. doi: 10.1002/jor.21379. In most cases, the full operative reports would PREOPERATIVE DIAGNOSES: 2017 May;27(4):433-439. doi: 10.1007/s00590-017-1945-5. However, the disadvantages include the potential of creating a stiffer foot; possibly overcorrecting the foot (which may lead to more symptoms); and a higher rate of specific complications, such as painful hardware, sural nerve irritation, and nonunion. 26.1 Incisions for lateral column lengthening (LCL; green) and posterior calcaneal osteotomy (red). The surgeon then cuts the outside of the heel bone and inserts a trapezoidal shaped bone graft into the lateral column. Forty percent or more talonavicular uncoverage on a standing AP X-ray of the foot. In adults, however, lengthening leads to calcaneocuboid arthritis. These codes all show Osteotomy so I am confused. The depth of the saw cut can be marked on the saw with a marking pen. There are two general ways of doing a lateral column lengthening, both of which involve taking a bone graft and inserting it into the lateral column. MeSH Such a patient most often preoperatively does not have subfibular impingement but can certainly have subtalar impingement. Lengthening the lateral column of the foot has been shown to correct flatfoot deformity. Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Inability to perform a single-leg heel raise (heel should invert). Results: Out of the 72 ft, 36.1% had separated anterior and middle facets in the calcaneus, and 63.8% had partly or completely fused anterior and middle facets. In an osteoporotic patient with significantly weak bone, an Evans procedure is preferable to a step-cut osteotomy (see section Lateral Column Lengthening Alternative Procedure: Step-cut Osteotomy) because of less chance of fracturing the bone with manipulation. Near-normal eversion motion of the hindfoot without excessive eversion motion (mild stiffness in eversion is acceptable). 1999 Nov;81(11):1545-60. doi: 10.2106/00004623-199911000-00006. 2013 Dec;6(4):294-303. doi: 10.1007/s12178-013-9173-z. There is, therefore, no single solution to this problem; the surgeon must treat each patient as an individual and choose the procedure that will work best in their hands for any given foot pathology they are presented with. official website and that any information you provide is encrypted Beimers L, Louwerens JW, Tuijthof GJ, Jonges R, van Dijk CN, Blankevoort L. Foot Ankle Int. Hallux elevatus Unable to load your collection due to an error, Unable to load your delegates due to an error. Clipboard, Search History, and several other advanced features are temporarily unavailable. Jul 18, 2019 | Posted by admin in SPORT MEDICINE | Comments Off on Evans Lateral Column Lengthening and Cotton Osteotomy. View matching HCPCS Level II codes and their definitions. government site. Fig. 26.1 Indications and Pathology The .gov means its official. Place a pin distractor with one pin right next to the calcaneocuboid joint and the other well posterior to the saw cut. This is helpful to assess possible lateral impingement at the subtalar joint and subfibular impingement. 26.3). You must log in or register to reply here. 2000 Sep;21(9):730-5. doi: 10.1177/107110070002100903. Triple arthrodesis or medial-approach double arthrodesis have been the standard but often do not provide enough correction of the deformity. Would you like email updates of new search results? The typical amount of lengthening of the lateral column is between 5 and 10 mm. He performs this procedure to treat conditions such as abnormally high or low arches or other conditions affecting foot alignment. 26.5). Clin Podiatr Med Surg. Flatfoot deformity with medial arch collapse. Bethesda, MD 20894, Web Policies Operative treatment of the difficult stage 2 adult acquired flatfoot deformity. Both products are available in several shapes and sizes, allowing surgeons to choose between a permanent structural implant or an allograft implant. I can't find a code for this. Moderate to severe osteoporosis. Click here to view our full disclaimer. Unable to passively bring the talonavicular joint into an adducted or inverted position. Please enable it to take advantage of the complete set of features! Boot or hinged anklefoot orthosis (AFO) brace. Lateral column lengthening (Evans Osteotomy) for adult acquired flatfoot is a surgical procedure designed to modify the shape of the foot and create an arch. Foot Ankle Clin. Medial-sided bony procedures: why, what, and how. 2013 Jun 19;95(12):1094-100. doi: 10.2106/JBJS.K.01032. HHS Vulnerability Disclosure, Help If the first metatarsal is elevated, it should be brought down to a good position in comparison to the second metatarsal head. Lateral incongruity of the talonavicular joint on a standing AP foot X-ray. sharing sensitive information, make sure youre on a federal Therefore, the lateral column lengthening procedure involves lengthening this region. Calcaneocuboid distraction arthrodesis and first metatarsocuneiform arthrodesis for correction of acquired flatfoot deformity in a cadaver model. If there is any space on either side between the graft and native bone, rotate or trim the graft slightly to achieve excellent apposition along the lateral and dorsal aspects of the osteotomy. Accessibility Fill out the form below and we will call you back. A flexor digitorum longus tendon transfer is usually performed in combination with the osteotomies in adult acquired flatfoot deformity with associated PTT pathology. The lateral column is made up of the calcaneus, the cuboid, and the fourth and fifth metatarsals (Figure 1). 26.1.1 Clinical Evaluation CPT 28300, Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes. An official website of the United States government. Epub 2015 Feb 9. 2001 Mar;6(1):95-119. doi: 10.1016/s1083-7515(03)00083-4. For the next 4-6 weeks (assuming the bone graft has healed), the patient can weight bear as tolerated in acast boot. I think you're on the right track. Disclaimer, National Library of Medicine Borderline X-ray findings of one or two, but the patient has excessive pronation (eversion and abduction) seen clinically by a severe flatfoot with sag in the arch just distal to the ankle but not at the level of the tarsometatarsal or naviculocuneiform joints. This correction effectively negates the loss of normal biomechanics created by the loss of the dynamic function of the posterior tibial tendon. Arthrex offers multiple implant options for lateral column lengthening procedures including the BioSync titanium porous wedges or the AlloSync allograft wedges. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Evans Lateral Column Lengthening and Cotton Osteotomy, 26 Evans Lateral Column Lengthening and Cotton Osteotomy, Evans Lateral Column Lengthening and Cotton Osteotomy, Flexor Digitorum Longus Transfer for Posterior Tibial Tendon Dysfunction, Naviculocuneiform Fusion to Treat Midfoot Arthritis and Deformity. I did google it though, and came up with a couple sites that used the same code. Clinically, there should be near-normal eversion motion remaining, but mild stiffness is acceptable (Fig. Only gold members can continue reading. Use the pin distractor to hold open the osteotomy and try different amounts of lengthening to correct the deformity. 2012 Jun;17(2):247-58. doi: 10.1016/j.fcl.2012.02.003. and transmitted securely. The interval between the facets can usually be identified bluntly with an elevator. A magnetic resonance imaging (MRI) scan is not essential, but it can be helpful to assess the condition of the spring ligament in cases with severe deformity. The most common amounts of LCL are in the range of 6 to 8 mm. It may not display this or other websites correctly. Curr Rev Musculoskelet Med. These findings demonstrate the need for clinical investigation of this procedure, which could preserve motion in the talonavicular and subtalar joints, correct deformity, and obviate calcaneocuboid arthritis. To view a list of all insurances that AOA Orthopedic Specialists accept, clickHERE. 26.1). Another method (my preferred method) is to use trial wedges in 1-mm increments or some instrument with the desired amounts of lengthening to judge the foot.1 Use the wedges or instrument inserted into the osteotomy to judge the correction. With the thin oscillating saw, make the osteotomy perpendicular to plantar aspect of the foot just distal to the K-wire into the medial cortex. [Problems in complex hindfoot corrections]. Surgeons often pair a lateral column lengthening with other procedures like a medializing calcaneal osteotomy. 4. Mobilize the peroneal tendons so that they can be retracted with a Bennett retractor to allow a saw cut into the lateral aspect of the anterior calcaneus. POSTOPERATIVE DIAGNOSES: A magnetic resonance imaging (MRI) scan is not essential, but it can be helpful to assess the condition of the spring ligament in cases with severe deformity. and transmitted securely. Arizona brace. Mosier-LaClair S, Pomeroy G, Manoli A 2nd. About 75% of the recovery occurs within the first 5-6 months. It seems to be closest to either 28304 or 28305. Posterior calcaneal displacement osteotomy for the adult acquired flatfoot. Patient is positioned supine. Thank you Plaidman. 26.3 Advantages of Surgical Procedure HHS Vulnerability Disclosure, Help 2014 Nov;43(11):1025-39; quiz 40. doi: 10.1007/s00132-014-3037-0. Disclaimer, National Library of Medicine During a lateral column lengthening, the foot and ankle surgeon makes a cut on the outside of the affected foot. The advantages of this procedure include the ability to take a pronounced flatfoot deformity and turn it into a near normal looking foot. What indicates the need for a lateral column lengthening? Therefore, the lateral column lengthening procedure involves lengthening this region. doi: 10.1016/j.cpm.2007.07.002. J Orthop Res. That situation will lead to an unsatisfied patient with lateral weight bearing. Lateral sliding calcaneal osteotomy was performed through an obliquely oriented incision made over the lateral wall of the calcaneus. Use a sinus tarsi incision extending from the tip of the fibula to the anterior process of the calcaneus (Fig. However, the disadvantages include the potential of creating a stiffer foot; possibly overcorrecting the foot (which may lead to more symptoms); and a higher rate of specific complications, such aspainful hardware,sural nerve irritation, andnonunion. Clin Podiatr Med Surg. Fix the osteotomy with two longitudinal 3.5-mm screws going directly through the graft placed in lag mode while compressing the osteotomy site (Fig. Unable to load your collection due to an error, Unable to load your delegates due to an error. The purpose of this article is to review the lateral column lengthening procedure through a detailed explanation of the operation, the postoperative care, and the pitfalls and complications of the procedure. Sci Rep. 2016 Oct 18;6:35493. doi: 10.1038/srep35493. Hi gsteeves. Despite an abundance of literature intricately detailing the biomechanical effects of different operative procedures on the hindfoot, there is no clear consensus as to the best procedure or procedures to perform for a flexible pes planovalgus foot deformity. An osteotomy (bone cut) of the calcaneus is performed right before the calcaneal-cuboid joint, which is then spread about 7-10 mm so that the bone graft can be inserted, in order to lengthen the column. Bethesda, MD 20894, Web Policies Have a question or need help finding the right doctor? Clinical and radiological results. However, full recovery can take up to 18 months. Also, on the coronal views of the CT scan, look for lateral subluxation of the subtalar joint, which probably indicates the need for a subtalar fusion. 26.1). 2001 Mar;6(1):95-119. doi: 10.1016/s1083-7515(03)00083-4. One way of performing this procedure is by cutting the bone (osteotomy) through the front part of the calcaneus. All surgeons have different protocols so patients must follow the protocol of their specific provider. The graft places pressure on the foot and brings the foot into a straighter position. About 75% of the recovery occurs within the first 5-6 months. Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study. There are two general ways of doing a lateral column lengthening, both of which involve taking a bone graft and inserting it into the lateral column. 28300, Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes. The calcaneus, the cuboid, and the fourth and fifth metatarsals make up the lateral column. Only gold members can continue reading. J Bone Joint Surg Am. If surgery has achieved these goals, the patient is likely to have a good functional outcome with minimal stiffness and minimal chance of recurrence of the collapsing foot. HHS Vulnerability Disclosure, Help Perform compression fixation of the osteotomies, especially the LCL. Achieve the right amount of correction taking care not to overcorrect, which is the most common mistake. 2001 Mar;6(1):95-119. doi: 10.1016/s1083-7515(03)00083-4. Note: Any of these options may help symptoms and possibly slow down progression, but they do not halt progression. Sensitivity of plantar pressure and talonavicular alignment to lateral column lengthening in flatfoot reconstruction. Progressive Flatfoot (Posterior Tibial Tendon Dysfunction) Disclaimer, National Library of Medicine Lengthening the lateral column of the foot has been shown to correct flatfoot deformity. PMC Foot Ankle Int. For a lateral column lengthening, orthopedic foot and ankle specialists may use pins, plates, screws, or other types of applicable hardware. I found ostectomy, fifth metatarsal head. Right PTTD That situation will lead to an unsatisfied patient with lateral weight bearing. Good luck! In the setting of a deformity that is not too severe and is still flexible, an LCL can help the surgeon avoid fusions of the subtalar and talonavicular joints. With the thin oscillating saw, make the osteotomy perpendicular to plantar aspect of the foot just distal to the K-wire into the medial cortex. 26.6.1 Lateral Column Lengthening: Evans Procedure 2012 May;33(5):386-93. doi: 10.3113/FAI.2012.0386. A flexor digitorum longus tendon transfer is usually performed in combination with the osteotomies in adult acquired flatfoot deformity with associated PTT pathology. I'm having a difficult time coding this same scenario myself. 269 Chestnut St. #271 Oh I, Imhauser C, Choi D, Williams B, Ellis S, Deland J. J Bone Joint Surg Am. Tendon lenghtening with osteotomy 27685 28200 osteotomy tendon lengthing, Arthrex Interna Brace reconstruction for pes plano valgus deformity arthrex brace flat foot ligament reconstruction podiatry spring ligament, help with surgery please identified incision joint screws tissue, Clubfoot DeformitiesGet a Full Range of Understanding. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Disclaimer: The Relief Institute has made reasonable efforts to present accurate information on this website; however, it is possible that information found on this website could potentially be out-of-date or limited in nature. Published by Elsevier Inc. All rights reserved. Children who underwent STA received a subdermal implant and were placed in below-knee walking casts for 3 weeks. Hold the osteotomy open to the desired amount of lengthening and fashion a tricortical allograft to fit that space. Clipboard, Search History, and several other advanced features are temporarily unavailable. The site is secure. Symptomatic arthritis of the subtalar, calcaneocuboid, or talonavicular joint. 2015 Jun;36(6):705-9. doi: 10.1177/1071100715571439. Correct alignment so that each of the following is achieved: No remaining subtalar or subfibular impingement. Epub 2017 Apr 10. Z Orthop Ihre Grenzgeb. Log In or Register to continue . Federal government websites often end in .gov or .mil. Confirm that the heel alignment is good after temporary fixation of the LCL and the posterior calcaneal osteotomy. Zhou H, Ren H, Li C, Xia J, Yu G, Yang Y. Biomed Res Int. The interval between the facets can usually be identified bluntly with an elevator. Unable to passively bring the talonavicular joint into an adducted or inverted position. Approach and treatment of the adult acquired flatfoot deformity. 2. Unable to load your collection due to an error, Unable to load your delegates due to an error. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults. Fashion the graft according to the ideal amount of correction as shown by looking at the osteotomy held open to the desired amount. Some conditions that may require this treatment include: If this tendon becomes inflamed, overstretched, or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot. Tr [QUOTE="jsalzer50, post: 388229, member: 320610"][size=3]keep in mind that i'm only a coding student, but i hope the codes i found at least point us in the right direction. FootEducation LLC Foot Ankle Int. Please enable it to take advantage of the complete set of features! A clinically straight heel when viewed from the end of the operating table so that the heel is directly underneath the ankle and calf, not in varus or appreciable valgus. Accessibility Orthopade. 2007 Oct;24(4):699-719, viii-ix. Right Hallux valgus Bookshelf Biomechanical consequences of lateral column lengthening of the calcaneus: Part I. Standing plain X-rays can underestimate deformity if patient is not allowing the arch to collapse, the patient is leaning back, or the X-ray is not properly centered over the talonavicular joint. The successful patient has near-normal eversion motion remaining in the hindfoot, and good alignment of the heel. A small bump can be placed under the ipsilateral hip to aid with the lateral column lengthening, although this may make the approach to the PTT more difficult during the tendon transfer procedure if the leg is rotated too internally. I agree that 28260 and 28300 do not appear to be appropriate for what was done. Unfallchirurg. Too much correction can result in a good-looking X-ray and no impingement, but the hindfoot still too stiff. 1. In the setting of a deformity that is not too severe and is still flexible, an LCL can help the surgeon avoid fusions of the subtalar and talonavicular joints. doi: 10.1016/j.cpm.2004.11.002. LRR can be performed as an isolated procedure or as an associated procedure.

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