Calcaneal Osteotomy: Medializing, Lateralizing, and Evans Procedures

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Calcaneal osteotomies — surgical procedures that cut and reposition the calcaneus (heel bone) to correct hindfoot alignment — are workhorses of foot and ankle reconstructive surgery for flatfoot, cavus foot, and various hindfoot deformities. By altering the mechanical alignment of the calcaneus relative to the tibia and midfoot, calcaneal osteotomies offload degenerated joints, redistribute plantar pressure, correct gait mechanics, and delay or prevent the need for more complex reconstructive procedures. Understanding the specific indications and mechanical goals of the three most common calcaneal osteotomies helps patients understand why their surgeon selected a particular procedure.

Medializing Calcaneal Osteotomy

The medializing calcaneal osteotomy (MCO) — the standard osteotomy for adult flatfoot deformity — is performed through the posterior calcaneal tuberosity: a transverse cut through the calcaneal body allows the posterior tuberosity (with the Achilles insertion) to be shifted medially by 10–12mm. Mechanical rationale: the calcaneus in valgus hindfoot alignment sits laterally displaced relative to the ankle joint — medializing the tuberosity shifts the ground reaction force from under the sustentaculum (medial) where it cannot support the arch, to directly beneath the tibial axis, reducing the valgus moment that drives progressive arch collapse. Combined with tibialis posterior repair/augmentation (FDL transfer) and spring ligament reconstruction — the ‘triple’ reconstruction for Stage II PTTD. Recovery: 6 weeks non-weight-bearing, then progressive weight-bearing; return to full activity at 3–4 months.

Lateralizing Calcaneal Osteotomy (Dwyer and Lateral Slide)

The lateralizing calcaneal osteotomy shifts the tuberosity laterally — used for cavus foot deformity where the calcaneus is in varus alignment. The Dwyer closing wedge osteotomy removes a medial wedge of bone from the posterior calcaneus (correcting calcaneal varus by shortening the medial column); combined with Achilles tendon lengthening if equinus is present. Restores hindfoot alignment in CMT disease and symptomatic calcaneal varus; typically combined with lateral ligament reconstruction, peroneus longus to brevis transfer, and dorsiflexion osteotomy of the first metatarsal for comprehensive cavus foot correction.

Evans Lateral Column Lengthening Osteotomy

The Evans osteotomy is a calcaneal opening wedge osteotomy just posterior to the calcaneocuboid joint — an allograft or autograft bone wedge (typically 8–12mm) is inserted into the anterior calcaneus to lengthen the lateral column of the foot. Mechanical rationale: lateral column lengthening restores the relationship between the calcaneus and cuboid, reduces abduction deformity of the midfoot (the ‘too many toes’ sign of flatfoot), and reduces peritalar subluxation — the primary mechanism of arch restoration in flexible flatfoot. Combined with MCO and soft tissue reconstruction for comprehensive Stage II PTTD reconstruction. Potential complication: calcaneocuboid joint overload from excessive lengthening — the graft length must be precisely sized to the deformity. Dr. Biernacki at Balance Foot & Ankle performs medializing calcaneal osteotomy, Evans lateral column lengthening, and Dwyer osteotomy as components of comprehensive flatfoot and cavus foot reconstruction. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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Expert Calcaneal Osteotomy Surgery in Michigan

Heel bone misalignment contributes to flatfoot, cavus foot, and chronic heel pain. Our board-certified podiatric surgeons perform medializing, lateralizing, and Evans calcaneal osteotomies to restore proper foot alignment and function.

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Clinical References

1. Myerson MS, Corrigan J, Thompson F, Schon LC. Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency. Foot Ankle Int. 1995;16(11):712-718.
2. Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br. 1975;57(3):270-278.
3. Mosier-LaClair S, Pomeroy G, Manoli A. Operative treatment of the difficult stage 2 adult acquired flatfoot deformity. Foot Ankle Clin. 2001;6(1):95-119.