Supramalleolar osteotomy combined with calcaneal osteotomy for the treatment of varus ankle arthritis with excessive talar tilt angle

Aims Varus ankle arthritis with excessive talar tilt (TT) angle often has unsatisfactory outcomes after supramalleolar osteotomy (SMOT) surgery. These patients have a 3D deformity involving the hind foot as well as the ankle. Thus, adjuvant correction of the hind foot component may contribute to the TT angle. This study aimed to explore whether calcaneal osteotomy combined with SMOT could effectively correct the hindfoot alignment to treat varus ankle arthritis with a large TT angle. Methods In total, 26 patients diagnosed with varus ankle arthritis with excessive TT angle were included in this study. Calcaneal osteotomy was combined with SMOT to correct the hindfoot alignment. Thus, a combination of supramalleolar and subtalar corrections was performed to improve the alignment of the lower limbs. Anterior and lateral radiographs of the weightbearing ankle were performed preoperatively and postoperatively. The tibial anterior surface angle, the tibial lateral surface angle, and TT angle were measured. The clinical efficacy was evaluated according to the American Orthopaedic Foot and Ankle Society scoring system and pain visual analogue scale. Results Preoperative varus hindfoot alignment was corrected to nearly normal via SMOT combined with calcaneal osteotomy. Radiological parameters demonstrated that SMOT combined with calcaneal osteotomy could significantly improve varus ankle arthritis and correct excessive TT angle. Moreover, the clinical outcomes of the patients were significantly improved and the pain was significantly relieved after the surgery. Conclusion We found that SMOT combined with calcaneal osteotomy significantly improved varus ankle arthritis with a significant reduction in TT angle. Therefore, with the correction of the subtalar alignment and the displacement of the talus centre, the hindfoot alignment can recovery effectively and the TT angle can be significantly reduced. This suggests that SMOT combined with calcaneal osteotomy is a practical surgical approach for varus ankle arthritis with excessive TT angle. Cite this article: Bone Jt Open 2025;6(11):1343–1348.