The Evans osteotomy is a surgical procedure aimed at correcting flatfoot deformities. It is especially useful in treating adult cases of pes planus, which is the medical term for flat feet. This surgery involves making an incision in the heel bone, specifically the calcaneus, to lengthen the lateral column of the foot. This procedure restores the proper alignment of the foot, improving both function and comfort for those suffering from this condition.
How Common It Is and Who Gets It? (Epidemiology)
The Evans osteotomy is typically performed on adults with flexible flatfoot deformities, often caused by tendon dysfunction, trauma, or other misalignments. It is particularly beneficial for those who have not found relief with conservative treatments like orthotics or physical therapy. This procedure can address conditions like pes planus, tarsal coalition, or forefoot misalignment.
Why It Happens – Causes (Etiology and Pathophysiology)
Flatfoot deformities, including pes planus, can be caused by various factors such as genetics, trauma, or tendon dysfunction. In adults, these deformities often lead to pain and instability in the foot, particularly in the medial column. The Evans osteotomy corrects these misalignments by lengthening the lateral column and restoring the arch of the foot.
How the Body Part Normally Works? (Relevant Anatomy)
The calcaneus, or heel bone, plays a critical role in foot function. The Evans osteotomy involves cutting and lengthening the lateral column of the foot, which includes the calcaneus, to correct misalignment and restore the arch. The procedure realigns the foot to improve its ability to support weight and facilitate proper movement.
What You Might Feel – Symptoms (Clinical Presentation)
Symptoms of flatfoot deformities may include pain in the arch or heel, especially when standing or walking for long periods. The foot may appear flattened, and the arch may be lost or reduced. There may also be ankle misalignment or difficulty wearing certain shoes due to the deformity.
How Doctors Find the Problem? (Diagnosis and Imaging)
A thorough physical examination, including assessment of foot structure and gait, is the first step in diagnosing flatfoot deformities. Imaging studies such as X-rays, CT scans, or MRIs are often used to confirm the diagnosis and assess the degree of misalignment in the foot.
Classification
Flatfoot deformities are classified by the degree of misalignment and the flexibility of the foot. Flexible flatfoot is characterized by a collapsing arch that can be corrected with surgery, whereas rigid flatfoot may require different surgical interventions. The Evans osteotomy is primarily used for flexible flatfoot.
Other Problems That Can Feel Similar (Differential Diagnosis)
Conditions such as posterior tibial tendon dysfunction, tarsal coalitions, or misaligned forefoot deformities can present with similar symptoms. Proper diagnosis is crucial to ensure that the Evans osteotomy is the appropriate treatment for the condition.
Treatment Options
Non-Surgical Care:
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- Orthotics and shoe modifications
- Physical therapy to strengthen the foot and improve flexibility
- Pain management with NSAIDs or corticosteroid injections
Surgical Care:
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- The Evans osteotomy is the primary surgical option for correcting flexible flatfoot deformities. It involves lengthening the lateral column of the foot to restore proper alignment and function.
Recovery and What to Expect After Treatment
Postoperative care involves wearing a non-weight-bearing cast or boot for several weeks. Gradual weight-bearing is allowed as healing progresses, and full recovery typically takes 3 to 6 months. Physical therapy is recommended to restore mobility, strength, and prevent stiffness during the recovery process.
Possible Risks or Side Effects (Complications)
- Delayed union or nonunion: The bone may take longer to heal or fail to heal properly.
- Avascular necrosis: Insufficient blood supply to the calcaneus may result in bone death.
- Nerve injury: Damage to nerves, such as the sural nerve, can lead to sensory problems.
- Subluxation: Shifting of the calcaneus during healing may require further intervention.
- Stress fractures: Stress fractures in the metatarsals or other bones can occur during recovery.
Long-Term Outlook (Prognosis)
The Evans osteotomy has a high success rate, with most patients experiencing significant pain relief and improved foot function. Most patients can return to normal activities after full recovery, though high-impact activities should be avoided for up to 6 months.
Out-of-Pocket Cost
Medicare
CPT Code 28304 – Evans Osteotomy (Calcaneal Osteotomy for Structural Foot Deformity Correction): $191.57
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work in coordination with Medicare to fill the coverage gap and reduce the patient’s financial responsibility.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.
Workers’ Compensation
If your Evans osteotomy is required due to a work-related injury or foot deformity caused by repetitive stress, Workers’ Compensation will cover all medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.
No-Fault Insurance
If your Evans osteotomy is needed due to an automobile accident or trauma, No-Fault Insurance will generally cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.
Example
Jessica Clark underwent Evans osteotomy (CPT 28304) to correct a deformity in her heel bone. Her estimated Medicare out-of-pocket cost was $191.57. Since Jessica had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the surgery.
Frequently Asked Questions (FAQ)
Q. What is the Evans Osteotomy?
A. The Evans Osteotomy is a surgical procedure used to treat adult flexible flatfoot deformities by lengthening the lateral column of the foot to restore proper alignment and function, particularly in cases of misalignment and painful conditions such as tendon dysfunction or trauma.
Q. How is the Evans Osteotomy performed?
A. The procedure involves making an incision on the outside of the ankle, cutting the calcaneus (heel bone) to lengthen the lateral column of the foot, and realigning the foot to restore the arch. The bones are held in place with screws or plates.
Q. What conditions are treated with the Evans Osteotomy?
A. The Evans Osteotomy is commonly used to treat adult flexible flatfoot, tarsal coalition, and foot deformities caused by tendon dysfunction or trauma, where other non-surgical treatments have failed.
Q. What is the recovery time for the Evans Osteotomy?
A. Recovery typically involves 6 to 8 weeks of non-weight-bearing in a cast or boot, followed by gradual weight-bearing. Full recovery can take 3 to 6 months, depending on the individual’s healing process.
Q. What are the risks associated with the Evans Osteotomy?
A. Risks include delayed or nonunion of the bone, nerve injury (particularly to the sural nerve), infection, stress fractures, and subluxation (shifting of the bone). These complications are rare but can occur.
Q. How long does the Evans Osteotomy procedure take?
A. The surgery usually takes about 1 to 2 hours, depending on the complexity of the deformity and the patient’s individual needs.
Q. Can the Evans Osteotomy be combined with other surgeries?
A. Yes, the Evans Osteotomy can be combined with other procedures like tendon transfers or joint fusions, depending on the severity of the foot deformity and the patient’s specific needs.
Q. Is the Evans Osteotomy suitable for everyone with flatfoot?
A. It is most effective for patients with flexible flatfoot deformities. Patients with rigid flatfoot, advanced arthritis, or other complicating factors may require a different surgical approach.
Q. Will I need physical therapy after the Evans Osteotomy?
A. Yes, physical therapy is often recommended to help restore strength, flexibility, and mobility in the foot and ankle, improve gait, and prevent stiffness during the recovery process.
Q. Can I walk immediately after the Evans Osteotomy?
A. No, you will need to refrain from putting weight on the foot for several weeks, typically using crutches or a walking boot. Gradual weight-bearing is introduced as the healing progresses.
Q. What is the success rate of the Evans Osteotomy?
A. The Evans Osteotomy has a high success rate, with most patients experiencing significant improvement in foot function, stability, and pain relief. Success rates generally range from 80% to 95%, depending on the severity of the deformity.
Q. Is the Evans Osteotomy a permanent solution for flatfoot?
A. Yes, the Evans Osteotomy is considered a permanent solution to correct flexible flatfoot deformities, though patients may need to follow rehabilitation guidelines to ensure long-term success.
Q. Will I be able to wear normal shoes after the Evans Osteotomy?
A. After full recovery, most patients can wear regular shoes, but some may need custom orthotics or shoes with specific support features to prevent recurrence of the deformity and ensure proper alignment.
Q. How soon can I return to sports after the Evans Osteotomy?
A. High-impact activities, such as running and jumping, should be avoided for at least 3 to 6 months until the foot has fully healed. Light activities can often be resumed after 6 to 8 weeks, depending on individual healing progress.
Q. Are there any long-term complications of the Evans Osteotomy?
A. Long-term complications are rare but can include arthritis in the adjacent joints, recurrence of deformities, or complications from hardware used during the procedure, such as loosening or irritation.
Q. How is the Evans Osteotomy different from other foot surgeries for flatfoot?
A. The Evans Osteotomy focuses on lengthening the lateral column of the foot to restore the arch and improve alignment, whereas other procedures, like the Lenke or Cotton osteotomy, may focus on realigning or fusing different parts of the foot, depending on the specific deformity.
Summary and Takeaway
The Evans osteotomy is a proven and effective procedure for treating adult flexible flatfoot deformities. It offers a long-term solution by correcting the structural misalignment in the foot, restoring the arch, and improving overall function. With a high success rate and a low complication rate, the procedure provides relief from pain and discomfort, allowing patients to return to normal activities after full recovery. While the surgery requires careful postoperative care and physical therapy, it remains an essential option for patients with persistent flatfoot deformities who have not responded to conservative treatments.
Clinical Insight & Recent Findings
A recent study published in Scientific Reports introduced an advanced computer-simulated model to refine outcomes for the Evans osteotomy, a common procedure for correcting adult flatfoot. Researchers used a highly detailed finite element analysis (FEA) to simulate how different graft sizes affect pressure on the calcaneocuboid (CC) joint, which often bears excess stress after surgery.
The model—validated against real patient imaging and pressure data—found that an optimal graft size of about 3 mm best balances arch restoration with minimal CC joint pressure. Larger grafts increased joint stress and risked overcorrection, while smaller grafts provided inadequate arch support.
The findings support a personalized, patient-specific approach to selecting graft size, potentially improving surgical precision and reducing complications like joint pain or arthritis after flatfoot correction. (“Study on optimizing graft size in Evans osteotomy – see PubMed.“)
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons specializing in foot and ankle surgery typically perform the Evans osteotomy. In some cases, a multidisciplinary team, including physical therapists and pain management specialists, may be involved in the preoperative and postoperative care.
When to See a Specialist?
If you have persistent pain, deformity, or difficulty walking due to flatfoot, it’s important to consult a specialist to determine if the Evans osteotomy or another surgical procedure is necessary.
When to Go to the Emergency Room?
You should seek emergency care if you experience severe pain, swelling, or an inability to move the foot following trauma, as this could indicate a serious injury or complication.
What Recovery Really Looks Like?
Recovery after the Evans osteotomy typically involves several weeks of non-weight-bearing activity, followed by gradual reintroduction to normal activities. Full recovery may take several months, with rehabilitation helping to restore mobility and strength.
What Happens If You Ignore It?
Ignoring a flatfoot deformity can lead to worsening pain, further deformity, and loss of mobility. Early intervention with procedures like the Evans osteotomy can prevent these complications and improve long-term outcomes.
How to Prevent It?
Preventing flatfoot deformities involves maintaining proper foot health, wearing appropriate footwear, and avoiding excessive stress or trauma to the feet. Regular foot check-ups can help identify early signs of deformities.
Nutrition and Bone or Joint Health
A balanced diet rich in calcium and vitamin D is essential for bone health, particularly during the recovery phase after an Evans osteotomy. Maintaining a healthy weight will also reduce strain on the feet.
Activity and Lifestyle Modifications
After surgery, you may need to avoid high-impact activities until full recovery is achieved. Low-impact exercises such as swimming or cycling are ideal for maintaining fitness without stressing the foot.
Dr. Mo Athar
