Which surgical procedure is indicated when the midtarsal joint won't lock when the heel is held in neutral?

• A. Lapidus procedure
• B. Dwyer osteotomy
• C. Young's osteotomy
• D. Evan's calcaneal osteotomy

Answer: (D)

When the midtarsal joint cannot lock with the heel held in neutral, the issue is often a shortened lateral column contributing to forefoot abduction and hindfoot valgus that destabilizes the midfoot. The goal is to restore lateral column length and realign the hindfoot so the midtarsal joint can assume a more stable, locked position.

Evan’s calcaneal osteotomy lengthens the lateral column of the foot by performing a calcaneal osteotomy and inserting bone graft laterally. This lengthening repositions the calcaneus and talus to reduce forefoot abduction and bring the hindfoot and midfoot into better alignment, allowing the midtarsal joint to lock and the arch to reconstitute.

The other procedures address different problems: a medializing calcaneal osteotomy (Dwyer) corrects hindfoot valgus by varus repositioning but does not lengthen the lateral column; Lapidus targets first-ray instability; Young’s osteotomy is used for other forefoot corrections. For a pattern where midtarsal unlocking is due to lateral column deficiency, Evan’s lateral column lengthening is the indicated choice.