Abstract
Posterior tibial tendon dysfunction (PTTD) is a common pathology of the foot and ankle.
Numerous techniques are available to reconstruct the flatfoot. Fusions and tendon
transfers are popular methods; however, a wide range of complications have been associated
with these procedures. The objective of the present study was to demonstrate the outcomes
of reconstructive surgery for flatfoot correction without tendon transfer or arthrodesis.
We performed a retrospective study of 43 patients and 56 feet who had undergone flatfoot
reconstructive surgery from November 2011 to June 2016, with a mean follow-up period
of 60 weeks (range 12 to 60 months). Each patient demonstrated a stage 2 flatfoot
deformity classified using the Johnson and Strom classification. Depending on the
patient's deformity, the procedures consisted of different variations of gastrocnemius
recession, medial displacement calcaneal osteotomy, Evans osteotomy, and Cotton osteotomy.
Six different preoperative and postoperative angles were radiographically measured
on each foot studied. In all cases, the differences in the preoperative versus postoperative
measurements were statistically significant (p < .003). We believe the foot and ankle surgeon can correct flatfoot deformity with
the use of extraarticular procedures and create a plantigrade functional foot without
fusion or tendon transfer.
Level of Clinical Evidence
Keywords
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References
- Tibialis posterior tendon dysfunction.Clin Orthop. 1989; 239: 197-206
- Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon.Instr Course Lect. 1997; 46: 393-405
- Tendon transfers in the treatment of the adult flatfoot.Foot Ankle Clin. 2014; 19: 29-48
- Plantar forces in flexor hallucis longus versus flexor digitorum longus transfer in adult acquire flatfoot deformity.Foot Ankle Int. 2013; 34: 1286-1293
- Treatment of posterior tibial dysfunction without the use of flexor digitorum tendon transfer: a retrospective study of 34 patients.J Foot Ankle Surg. 2011; 50: 293-298
- Plantarflexion opening wedge medial cuneiform osteotomy for correction of fixed forefoot varus associated with flatfoot deformity.Foot Ankle Int. 2004; 25: 568-574
- Double calcaneal osteotomy realignment considerations in eight patients.J Am Podiatr Med Assoc. 2005; 95: 53-59
- Double calcaneal osteotomy with percutaneous Steinmann pin fixation as part of treatment for flexible flatfoot deformity: a review of consecutive cases highlighting our experience with pin fixation.J Foot Ankle Surg. 2015; 54: 478-482
- Cotton osteotomy in flatfoot reconstruction: a review of consecutive cases.J Foot Ankle Surg. 2017; 56: 990-995
- Pediatric flatfoot pearls and pitfalls.Foot Ankle Clin. 2017; 22: 643-656
- Flexible pediatric and adolescent pes planovalgus: conservative and surgical treatment options.Clin Podiatr Med Surg. 2010; 27: 59-77
- Addressing stage II posterior tibial tendon dysfunction: biomechanically repairing the osseous structures without the need of performing the flexor digitorum longus transfer.Clin Podiatr Med Surg. 2014; 31: 391-404
- Recovery of the posterior tibial muscle after late reconstruction following tendon rupture.Foot Ankle Int. 2004; 25: 85-95
- Effect of extra-osseous talotarsal stabilization on posterior tibial tendon strain in hyperpronating feet.J Foot Ankle Surg. 2011; 50: 676-681
- A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flatfoot.Clin Biomech (Bristol, Avon). 2009; 4: 385-390
- Clinical significance of magnetic resonance imaging in preoperative planning for reconstruction of posterior tibial tendon ruptures.Foot Ankle. 1992; 13: 208-214
- Risk of neurovascular injuries in flexor hallucis longus and flexor digitorum longus tendons.Foot Ankle Int. 2006; 27: 528-532
- Outcome following addition of peroneus brevis tendon transfer to treatment of acquire posterior tibial tendon insufficiency.Foot Ankle Int. 2001; 22: 301-304
- Management of the recurrent deformity in a flexible foot following failure of tendon transfer: is arthrodesis necessary?.Foot Ankle Clin. 2012; 17: 299-307
- Surgical principles.in: Hansen S.T. Functional Reconstruction of the Foot and Ankle. Lippincott, Williams & Wilkins, Philadelphia2000: 10-31
- Minimizing the role of fusion in the rigid flatfoot.Foot Ankle Clin. 2012; 17: 337-349
- Calcaneal lengthening for valgus deformity of the hindfoot: results in children who had severe, symptomatic flatfoot and skewfoot.J Bone Joint Surg Am. 1995; 77: 500-512
- Treatment of mobile flat foot by displacement osteotomy of the calcaneus.J Bone Joint Surg Br. 1971; 53: 96-100
- Calcaneo-valgus deformity.J Bone Joint Surg Br. 1975; 57B: 270-278
- Foot statistics and surgery.N Engl J Med. 1936; 214: 353-362
Article info
Publication history
Published online: March 30, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
