1096 Foot & Ankle International 40(9) Figure 1. Flowchart of the study's chronological events. AOFAS, American Orthopaedic Foot & Ankle Society; VAS, visual analog scale. the posterior arm of the incision was placed between the fibula and Achilles tendon toward the Achilles tendon to avoid injury of the sural nerve. The horizontal arm was placed in line with the base of the fifth metatarsal to avoid any skin complications (Figure 4). A full-thickness flap was developed. Lateral wall exostectomy was done using an osteotome until a clear area was made at the tip of the fibula. An oblique lateral closing calcaneal osteotomy was done starting at a superior point just anterior to the Achilles tendon to an inferior point anterior to the posterior calcaneal tuberosity; another parallel limb was made using a saw 1cm anterior to the other limb. Both osteotomy limbs connected at the medial cortex of the calcaneus (some lateral translation could also be done in the case of severe varus deformity). A lamina spreader was used to improve visualization of the subtalar joint. The residual cartilage and sclerotic