eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Acquired Flatfoot: Follow-up

Author: R Todd Hockenbury, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, University of Louisville
Contributor Information and Disclosures

Updated: Apr 23, 2009

Outcome and Prognosis

See Treatment, Surgical therapy for outcomes of various surgical procedures.

Future and Controversies

Treatment of stage 1 posterior tibial tendon dysfunction is straightforward. The goal is to halt the progression of tenosynovitis through conservative or operative methods in order to prevent tendon rupture. The rigid deformities of stages 3 and 4 require operative correction and fusion of the involved joints in order to produce a plantigrade balanced foot. The principle of fusing the fewest number of joints possible should be followed.

Surgical treatment of stage 2 posterior tibial tendon dysfunction generates the most controversy among foot and ankle surgeons. Many different surgical procedures have demonstrated good short-term relief of pain and improved function but limited ability to correct deformity. A tendon transfer using FDL or FHL tendon yields satisfactory short-term pain relief, but arch correction is not achieved. The addition of a medial displacement calcaneal osteotomy improves heel valgus position but may not produce complete correction of the medial longitudinal arch. A lateral column-lengthening procedure through the anterior calcaneus or through the calcaneocuboid joint achieves arch correction, but it requires iliac crest tricortical graft and risks nonunion or overcorrection.

In patients who are large or obese, subtalar or talonavicular fusion may be needed to achieve long-term correction, although these procedures limit hindfoot motion significantly. Perhaps the most biomechanically sound surgical treatments are those using tendon transfer to substitute for the deficient posterior tibial tendon, with lateral column lengthening to restore alignment of the subtalar and talonavicular joints and medial fusion of the sagging naviculocuneiform joint or first metatarsocuneiform joint. These procedures require multiple steps, multiple incisions, and prolonged recovery time. Perhaps the most important unanswered question is whether arch correction is required to achieve a long-term satisfactory outcome.

 


More on Acquired Flatfoot

Overview: Acquired Flatfoot
Workup: Acquired Flatfoot
Treatment: Acquired Flatfoot
Follow-up: Acquired Flatfoot
Multimedia: Acquired Flatfoot
References
Further Reading
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Keywords

flat foot, flatfoot, pes planus, acquired adult flatfoot, posterior tibial tendon dysfunction, PTT dysfunction, posterior tibial tendon insufficiency, PTT insufficiency, Chopart joint, too-many-toes sign, too many toes sign, Evans calcaneal osteotomy, Evans' calcaneal osteotomy

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Contributor Information and Disclosures

Author

R Todd Hockenbury, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, University of Louisville
R Todd Hockenbury, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Kentucky Medical Association
Disclosure: Nothing to disclose.

Medical Editor

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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