Original Research| Volume 49, ISSUE 5, P411-416, September 2010

The Modified Kidner-Cobb Procedure for Symptomatic Flexible Pes Planovalgus and Posterior Tibial Tendon Dysfunction Stage II: Review of 50 Feet in 39 Patients


      Symptomatic flatfoot is a prevalent disorder. We undertook a review of 50 feet in 39 patients with flexible flatfoot treated between August 2000 and January 2008 in order to evaluate the modified Kidner-Cobb procedure. Overall clinical results were rated as good in 48 (96%) feet and fair in 2 (4%) feet, and there were no poor results. Average follow-up was 4.6 years, and total recovery time was 5.7 months in older patients and 3.7 months in children. Manual muscle-strength testing revealed no difference in tibialis anterior strength between the operated and contralateral extremity. All patients visually demonstrated postoperative elevation of the medial longitudinal arch height. Complications included 2 feet with wound dehiscence and 1 foot with fractured hardware. The results of this review indicate that the modified Kidner-Cobb procedure is a useful treatment option for patients with symptomatic flexible flatfoot with posterior tibial tendon dysfunction stage 2.

      Level of Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nelson S.C.
        • Haycock D.M.
        • Little E.R.
        Flexible flatfoot treatment with arthroereisis: radiographic improvement and child health survey analysis.
        J Foot Ankle Surg. 2004; 43: 144-155
        • McCormack A.P.
        • Ching R.P.
        • Sangeorzan B.J.
        Biomechanics of procedures used in adult flatfoot deformity.
        Foot Ankle Clin. 2001; 6: 15-23
        • Cohen-Sobel E.
        • Giorgini R.
        • Velez Z.
        Combined technique for surgical correction of the pediatric severe flexible flatfoot.
        J Foot Ankle Surg. 1995; 34: 183-194
        • Hansen S.T.
        The cavovarus foot (medial peritalar subluxation).
        in: Hansen S.T. Functional Reconstruction of the Foot and Ankle, p 211. Lippincott Williams & Wilkins, Philadelphia2000
        • Holmes G.P.
        • Mann R.A.
        Possible epidemiological factors associated with rupture of posterior tibial tendon.
        Foot Ankle. 1992; 13: 70-79
        • Pomeroy G.C.
        • Pike R.H.
        • Beals T.C.
        • Manoli II, A.
        Current concepts review: acquired flatfoot in adults due to dysfunction of the posterior tibial tendon.
        J Bone Joint Surg. 1999; 81A: 1173-1182
        • Baravarian B.
        • Zgonis T.
        • Lowery C.
        Use of the Cobb procedure in the treatment of posterior tibial tendon dysfunction.
        Clin Podiatr Med Surg. 2002; 19: 371-389
        • Koutsogiannis E.
        Treatment of mobile flatfoot by displacement osteotomy of the calcaneus.
        J Bone Joint Surg. 1971; 53B: 96-100
        • Prichasuk S.
        • Sinphurmsukskul O.
        Kidner procedure for symptomatic accessory navicular and its relationship to pes planus.
        Foot Ankle. 1995; 16: 500-503
        • Kidner F.C.
        The pre hallux (accessory scaphoid) in its relationships to the flat foot.
        J Bone Joint Surg. 1929; 11: 831-837
        • Sullivan J.A.
        • Miller W.A.
        The relationship of the accessory navicular to the development of the flatfoot.
        Clin Orthop. 1979; 144: 233-237
        • Strayhorn G.
        • Puhl J.
        The symptomatic accessory navicular bone.
        J Fam Pract. 1982; 15: 59-64
        • Lowman C.L.
        An operative method for the correction of certain forms of flatfoot.
        JAMA. 1923; 81: 1500-1502
        • Weil L.S.
        The Cobb procedure for stage II posterior tibial tendon dysfunction.
        Clin Podiatr Med Surg. 1999; 16: 471-473
        • Helal B.
        Cobb repair for tibialis posterior tendon rupture.
        J Foot Surg. 1990; 29: 349-352
        • Janis L.R.
        • Wagner J.T.
        • Kravitz R.D.
        • Greenberg J.J.
        Posterior tibial tendon rupture: classification, modified surgical repair, and retrospective study.
        J Foot Ankle Surg. 1993; 32: 2-13
        • Weil Jr., L.S.
        • Benton-Wiel W.
        • Borrelli A.H.
        • Weil Sr., L.S.
        Outcomes for surgical correction for stages II and III tibialis posterior dysfunction.
        J Foot Ankle Surg. 1998; 37: 467-471
        • Knupp M.
        • Hintermann B.
        The Cobb procedure for treatment of acquired flatfoot deformity associated with stage II insufficiency of the posterior tibial tendon.
        Foot Ankle Int. 2007; 28: 416-421
        • Mahan K.T.
        • Flanigan K.P.
        Pathologic pes valgus disorders.
        in: Banks A.S. Downey M.S. Martin D.E. Miller S.J. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Lippincott Williams & Wilkins, Philadelphia2001: 869-879
        • Funk D.A.
        • Cass J.R.
        • Johnson K.A.
        Acquired adult flatfoot secondary to stage I posterior tendon pathology.
        J Bone Joint Surg. 1986; 68A: 95-102
        • Rosenberg Z.S.
        • Jahss M.H.
        • Noto A.M.
        • Shereff M.J.
        • Cheung Y.
        • Frey C.C.
        • Norman A.
        Rupture of the posterior tibial tendon: CT and surgical findings.
        Radiology. 1988; 176: 489-493
        • Johnson K.A.
        • Strom D.E.
        Tibialis posterior tendon dysfunction.
        Clin Orthop. 1989; 239: 196-206
        • Conti S.
        • Michelson J.
        • Jahss M.
        Clinical significance of magnetic resonance imaging in preoperative planning for reconstruction of posterior tibial tendon ruptures.
        Foot Ankle. 1992; 13: 208-214
        • Medical Research Council
        Special Report series no 282. Her Majesty's Stationary Office, London1954
        • Bates B.
        The nervous system.
        in: Bates B. A Guide to Physical Examination and History Taking. J.B. Lippincott Company, Philadelphia1987: 490
        • Gulur P.
        • Rodi S.W.
        • Washington T.A.
        • Cravero J.P.
        • Fanciullo G.J.
        • McHugo G.J.
        • Baird J.C.
        Computer face scale for measuring pediatric pain and mood.
        J Pain. 2008; 10: 173-179
        • Mueller T.J.
        Acquired flatfoot secondary to tibialis posterior dysfunction: biomechanical aspects.
        J Foot Surg. 1991; 30: 2-11
        • Giorgini R.J.
        • Schiraldi F.G.
        • Hernandez P.A.
        Subtalar arthroereisis: a combined technique.
        J Foot Surg. 1988; 27: 157-161
        • vanAman S.E.
        • Schon L.C.
        Subtalar arthroereisis as adjunct treatment for type II posterior tibial tendon deficiency.
        Tech Foot Ankle Surg. 2006; 5: 117-125
        • Giannini S.
        • Ceccarelli F.
        • Benedetti M.G.
        • Catani C.F.
        Surgical treatment of flexible flatfoot in children.
        J Bone Joint Surg Am. 2001; 83-A: 73-79
        • Myerson M.S.
        Instructional Course Lectures, The American Academy of Orthopaedic Surgeons—Adult Acquired Flatfoot Deformity. Treatment of Dysfunction of the Posterior Tibial Tendon.
        J Bone Joint Surg Am. 1996; 76: 780-792
        • Pomeroy G.C.
        • Manoli II, A.
        A new operative approach for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report.
        Foot Ankle. 1997; 18: 206-212
        • Frankel J.P.
        • Turf R.M.
        • Kuzmicki L.M.
        Double calcaneal osteotomy in the treatment of posterior tibial tendon dysfunction.
        J Foot Ankle Surg. 1995; 34: 254-261
        • Weinraub G.M.
        • Heilala M.A.
        Adult flatfoot/posterior tibial tendon dysfunction: outcomes analysis of surgical treatment utilizing an algorithmic approach.
        J Foot Ankle Surg. 2000; 39: 359-364