eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Acquired Flatfoot

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

Updated: Apr 23, 2009

Introduction

History of the Procedure

Kulowski first described tenosynovitis of the posterior tibial tendon in 1936.1 Key described surgical findings of partial posterior tibial tendon rupture in 1953.2 In 1974, Goldner et al described the surgical treatment of 9 patients with posterior tibial tendon dysfunction.3 In the early 1980s, Jahss, Mann, and Johnson recognized posterior tibial tendon dysfunction as a common cause of acquired adult flatfoot.4,5,6

Problem

Adult flatfoot refers to a deformity that develops after skeletal maturity is reached. Adult flatfoot should be differentiated from constitutional flatfoot, which is a common congenital nonpathologic foot morphology.7,8

Etiology

There are numerous causes of acquired adult flatfoot, including fracture or dislocation, tendon laceration, tarsal coalition, arthritis, neuroarthropathy, neurologic weakness, and iatrogenic causes. The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction. This article focuses primarily on the diagnosis and treatment of this condition.

The etiology of posterior tibial tendon dysfunction is varied; it is attributed to degenerative, inflammatory, and traumatic causes. In 1 study, 60% of patients were obese or had diabetes mellitus, hypertension, previous surgery or trauma to the medial foot, or treatment with steroids. Myerson has described 2 subsets of patients with posterior tibial tendon dysfunction.9 One patient group was younger with associated enthesopathies at multiple sites, a higher incidence of HLA-B27 positivity, and a significant family history for inflammatory disease and psoriasis, thus suggesting a seronegative spondyloarthropathy. The other patient group was older and had isolated dysfunction, suggesting a purely mechanical degenerative cause.

Arthropathies can result in posterior tibial tendon dysfunction as well. In 1 study, 11% of 99 rheumatoid patients were found to have posterior tibial tendon pathology.10 A zone of tendon hypovascularity exists 1-1.5 cm distal to the medial malleolus, continuing 14 mm distally. Poor blood supply in this area of the tendon, where it takes a sharply curving course around the medial malleolus, could result in tendon degeneration and may explain a mechanical cause for tendon rupture.

A study by Dyal et al compared weightbearing radiographs of symptomatic feet with posterior tibial tendon dysfunction to those of the contralateral asymptomatic feet.11 Interestingly, there was strong correlation between the measurements of both feet, leading the authors to suggest that a predisposing constitutional flatfoot may be a possible etiologic factor in the development of dysfunction. The authors cautioned against using radiographic measurements alone for diagnosis.

Pathophysiology

The medial longitudinal arch has both passive and active support. The 3 most important static contributors to arch stability, in order of importance, are the plantar fascia, the long and short plantar ligaments, and the spring ligament (calcaneonavicular ligament). The spring ligament forms a sling for the talar head, which prevents medial and plantar migration of the talar head and provides static arch support. The major dynamic stabilizer for the arch is the posterior tibial tendon.12

Contraction of the posterior tibial tendon causes inversion of the midfoot and elevation of the medial longitudinal arch through its broad insertion on the navicular, cuneiforms, medial 3 metatarsal bases, and cuboid.

The posterior tibial tendon also indirectly affects hindfoot inversion due to its course running behind the medial malleolus and its close association with the deep deltoid and spring ligaments. With hindfoot inversion, the axes of the talonavicular and calcaneocuboid joints diverge, and the transverse tarsal joint (Chopart joint) becomes locked, which transforms the foot into a rigid lever.

Loss of posterior tibial function due to stretching or rupture of the tendon removes the primary inverter of the foot and leaves the primary and secondary everters of the foot, the peroneus brevis and longus, relatively unopposed. Therefore, posterior tibial dysfunction leads to flattening of the medial longitudinal arch, forefoot abduction, and hindfoot valgus. During the late stance phase of gait, the patient loses push-off strength due to inability to invert the hindfoot and achieve forefoot rigidity. With loss of the posterior tibial tendon function, the powerful gastrocsoleus complex acts at the talonavicular joint instead of at the level of the metatarsal heads.

The talar head is then pushed downward and medially, stretching the calcaneonavicular (spring) ligament. Continued weight bearing on the medial side of the heel eventually leads to deltoid ligament insufficiency and valgus instability of the ankle. Three-dimensional CT analysis of patients with acquired flatfoot has documented subluxation of the subtalar joint with less contact between all 3 facets of the calcaneus and talus compared to controls.

Presentation

The patient with posterior tibial tendon dysfunction initially complains of pain and swelling in the medial ankle and midfoot during weight bearing. Over time, the patient may notice loss of the arch and the tendency to walk on the inner border of the foot. Loss of push-off strength during gait occurs, and the patient may develop a limp. As the patient's heel displaces into valgus and the forefoot abducts, pressure between the calcaneus and fibula may develop, causing painful impingement between the lateral ankle and calcaneus. Abnormal wear of the medial heel and inner border of shoe wear may also be noted.

The patient is first examined while standing, allowing comparison of the symptomatic to the asymptomatic foot. Arch height is assessed and compared with the asymptomatic foot. In later stages of posterior tibial tendon dysfunction, the arch is lowered and the forefoot abducted. Viewing the patient's foot from behind allows the examiner to evaluate forefoot abduction and heel valgus. The toes visible lateral to the heel are counted. The finding of 1 or 2 toes visible lateral to the heel is normal. In cases of significant forefoot abduction, 3 or more toes are visible. This too-many-toes sign is a test to confirm forefoot abduction (see Image 1).

Too-many-toes sign. Three lateral toes are visibl...

Too-many-toes sign. Three lateral toes are visible on the symptomatic left foot compared to only 2 toes on the right foot (black arrow). The medial midfoot is prominent and swollen (yellow arrow).

[ CLOSE WINDOW ]
Too-many-toes sign. Three lateral toes are visibl...

Too-many-toes sign. Three lateral toes are visible on the symptomatic left foot compared to only 2 toes on the right foot (black arrow). The medial midfoot is prominent and swollen (yellow arrow).


Single-limb heel rise. A patient with posterior t...

Single-limb heel rise. A patient with posterior tibial tendon dysfunction is unable to rise up on the toes because of an inability to invert the hindfoot.

[ CLOSE WINDOW ]
Single-limb heel rise. A patient with posterior t...

Single-limb heel rise. A patient with posterior tibial tendon dysfunction is unable to rise up on the toes because of an inability to invert the hindfoot.


Fixed forefoot varus is characterized by elevatio...

Fixed forefoot varus is characterized by elevation of the medial side of the forefoot, even after the heel is placed in a neutral position.

[ CLOSE WINDOW ]
Fixed forefoot varus is characterized by elevatio...

Fixed forefoot varus is characterized by elevation of the medial side of the forefoot, even after the heel is placed in a neutral position.


The angle that the heel forms with the longitudinal axis of the lower leg also should be measured. This posterior tibiocalcaneal angle is increased in cases of significant heel valgus. The patient should then be asked to stand on 1 foot and rise up on the toes. The patient usually needs to hold on to the examining table or wall for balance during this maneuver. Normally, the heel inverts as the posterior tibial muscle contracts and as the gastrocsoleus fires. In cases of posterior tibial tendon dysfunction, the heel does not invert, and the patient finds this single-limb heel rise maneuver painful, difficult, or impossible (see Image 2).

The patient then is examined seated on the examining table, and the course of the posterior tibial tendon is palpated for tenderness. Swelling along the posterior tibial tendon heath may be noted, and fluid may be palpated within the sheath. Posterior tibial strength is tested by holding the forefoot in a position of plantar flexion and eversion and asking the patient to invert the foot. During this maneuver, the posterior tibial tendon should be palpated to assess its continuity. The sinus tarsi and distal fibular area also should be palpated for tenderness because in later stages of posterior tibial tendon dysfunction, these areas of impingement may also be painful. The knee is extended, the foot is held in a subtalar neutral position, and passive ankle dorsiflexion is measured.

Usually, 10-20° of dorsiflexion is possible, but in cases of long-standing pes planus, dorsiflexion past neutral is often limited because of the development of a plantar flexion contracture. During the final stages of posterior tibial tendon dysfunction, the subtalar joint may be fixed in eversion, and inversion to neutral may be impossible. Finally, forefoot flexibility is assessed by pronating and supinating the forefoot while holding the heel in neutral position. Although the subtalar joint may be flexible, the transverse tarsal joint may have become fixed in varus, preventing plantigrade positioning of the forefoot (see Image 3). This finding has important implications for surgical treatment.

Indications

Indications for treatment of posterior tibial tendon dysfunction are disabling pain, deformity, shoe wear problems, and difficulty with ambulation. A painless deformity that can be accommodated by normal footwear and allows for normal gait does not require treatment.

Relevant Anatomy

See Pathophysiology for relevant anatomy.

Contraindications

Contraindications to surgical treatment are active or chronic infection, open ulceration, and severe peripheral vascular disease. A relative contraindication to surgical treatment is peripheral neuropathy with loss of protective sensation.

More on Acquired Flatfoot

Overview: Acquired Flatfoot
Workup: Acquired Flatfoot
Treatment: Acquired Flatfoot
Follow-up: Acquired Flatfoot
Multimedia: Acquired Flatfoot
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Kulowski J. Tendovaginitis (tenosynovitis): general discussion and report of one case involving the posterior tibial tendon. Missouri State Med Assoc. 1936;33:135-7.

  2. Key JA. Partial rupture of the tendon of the posterior tibial muscle. J. Bone Joint Surg. 1953;35A:1006-8.

  3. Goldner JL, Keats PK, Bassett FH 3rd, Clippinger FW. Progressive talipes equinovalgus due to trauma or degeneration of the posterior tibial tendon and medial plantar ligaments. Orthop Clin North Am. Jan 1974;5(1):39-51. [Medline].

  4. Jahss MH. Spontaneous rupture of the tibialis posterior tendon: clinical findings, tenographic studies, and a new technique of repair. Foot Ankle. Nov-Dec 1982;3(3):158-66. [Medline].

  5. Mann RA. Acquired flatfoot in adults. Clin Orthop Relat Res. Dec 1983;46-51. [Medline].

  6. Johnson KA. Tibialis posterior tendon rupture. Clin Orthop. Jul-Aug 1983;(177):140-7. [Medline].

  7. Deland JT. Adult-acquired flatfoot deformity. J Am Acad Orthop Surg. Jul 2008;16(7):399-406. [Medline].

  8. Vittore D, Patella V, Petrera M, Caizzi G, Ranieri M, Putignano P, et al. Extensor deficiency: first cause of childhood flexible flat foot. Orthopedics. Jan 2009;32(1):[Medline].

  9. Myerson M, Solomon G, Shereff M. Posterior tibial tendon dysfunction: its association with seronegative inflammatory disease. Foot Ankle. Apr 1989;9(5):219-25. [Medline].

  10. Michelson J, Easley M, Wigley FM, Hellmann D. Posterior tibial tendon dysfunction in rheumatoid arthritis. Foot Ankle Int. Mar 1995;16(3):156-61. [Medline].

  11. Dyal CM, Feder J, Deland JT, Thompson FM. Pes planus in patients with posterior tibial tendon insufficiency: asymptomatic versus symptomatic foot. Foot Ankle Int. Feb 1997;18(2):85-8. [Medline].

  12. Queen RM, Mall NA, Nunley JA, Chuckpaiwong B. Differences in plantar loading between flat and normal feet during different athletic tasks. Gait Posture. Jun 2009;29(4):582-6. [Medline].

  13. Conti S, Michelson J, Jahss M. Clinical significance of magnetic resonance imaging in preoperative planning for reconstruction of posterior tibial tendon ruptures. Foot Ankle. May 1992;13(4):208-14. [Medline].

  14. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop. Feb 1989;(239):196-206. [Medline].

  15. Marzano R. Functional bracing of the adult acquired flatfoot. Clin Podiatr Med Surg. Oct 2007;24(4):645-56, vii. [Medline].

  16. Chao W, Wapner KL, Lee TH, et al. Nonoperative management of posterior tibial tendon dysfunction. Foot Ankle Int. Dec 1996;17(12):736-41. [Medline].

  17. Teasdall RD, Johnson KA. Surgical treatment of stage I posterior tibial tendon dysfunction. Foot Ankle Int. Dec 1994;15(12):646-8. [Medline].

  18. Hix J, Kim C, Mendicino RW, Saltrick K, Catanzariti AR. Calcaneal osteotomies for the treatment of adult-acquired flatfoot. Clin Podiatr Med Surg. Oct 2007;24(4):699-719, viii-ix. [Medline].

  19. Gleich A. Beitrag zur operativen Plattfussbehandlung. Arch Klin Chir. 1893;46:358-62.

  20. Koutsogiannis E. Treatment of mobile flat foot by displacement osteotomy of the calcaneus. J Bone Joint Surg Br. Feb 1971;53(1):96-100. [Medline].

  21. Sammarco GJ, Hockenbury RT. Treatment of stage II posterior tibial tendon dysfunction with flexor hallucis longus transfer and medial displacement calcaneal osteotomy. Foot Ankle Int. Apr 2001;22(4):305-12. [Medline].

  22. Thomas RL, Wells BC, Garrison RL, Prada SA. Preliminary results comparing two methods of lateral column lengthening. Foot Ankle Int. Feb 2001;22(2):107-19. [Medline].

  23. Hardy MA, Logan DB. Principles of arthrodesis and advances in fixation for the adult acquired flatfoot. Clin Podiatr Med Surg. Oct 2007;24(4):789-813, x. [Medline].

  24. Kitaoka HB, Luo ZP, An KN. Subtalar arthrodesis versus flexor digitorum longus tendon transfer for severe flatfoot deformity: an in vitro biomechanical analysis. Foot Ankle Int. Nov 1997;18(11):710-5. [Medline].

  25. Stephens HM, Walling AK, Solmen JD, Tankson CJ. Subtalar repositional arthrodesis for adult acquired flatfoot. Clin Orthop. Aug 1999;(365):69-73. [Medline].

  26. Johnson JE, Cohen BE, DiGiovanni BF, Lamdan R. Subtalar arthrodesis with flexor digitorum longus transfer and spring ligament repair for treatment of posterior tibial tendon insufficiency. Foot Ankle Int. Sep 2000;21(9):722-9. [Medline].

  27. Chi TD, Toolan BC, Sangeorzan BJ, Hansen ST Jr. The lateral column lengthening and medial column stabilization procedures. Clin Orthop. Aug 1999;(365):81-90. [Medline].

  28. Maskill MP, Loveland JD, Mendicino RW, Saltrick K, Catanzariti AR. Triple arthrodesis for the adult-acquired flatfoot deformity. Clin Podiatr Med Surg. Oct 2007;24(4):765-78, x. [Medline].

  29. Lee MS, Maker JM. Revision of failed flatfoot surgery. Clin Podiatr Med Surg. Jan 2009;26(1):47-58. [Medline].

  30. Ananthakrisnan D, Ching R, Tencer A, et al. Subluxation of the talocalcaneal joint in adults who have symptomatic flatfoot. J Bone Joint Surg Am. Aug 1999;81(8):1147-54. [Medline].

  31. Cooper PS, Nowak MD, Shaer J. Calcaneocuboid joint pressures with lateral column lengthening (Evans) procedure. Foot Ankle Int. Apr 1997;18(4):199-205. [Medline].

  32. Cracchiolo A. Evaluation of spring ligament pathology in patients with posterior tibial tendon rupture, tendon transfer, and ligament repair. Foot Ankle Clin. 1997;2:297-307.

  33. Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br. Aug 1975;57(3):270-8. [Medline].

  34. Fadale PD, Wiggins ME. Corticosteroid Injections: Their Use and Abuse. J Am Acad Orthop Surg. May 1994;2(3):133-140. [Medline].

  35. Fairbank A, Myerson MS, Fortin P. The effect of calcaneal osteotomy on contact characteristics of the tibiotalar joint. Foot Ankle Int. 1995;5:137-42.

  36. Frey C, Shereff M, Greenidge N. Vascularity of the posterior tibial tendon. J Bone Joint Surg Am. Jul 1990;72(6):884-8. [Medline].

  37. Funk DA, Cass JR, Johnson KA. Acquired adult flat foot secondary to posterior tibial-tendon pathology. J Bone Joint Surg Am. Jan 1986;68(1):95-102. [Medline].

  38. Gazdag AR, Cracchiolo A 3rd. Rupture of the posterior tibial tendon. Evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair. J Bone Joint Surg Am. May 1997;79(5):675-81. [Medline].

  39. Gould JS. Direct repair of the posterior tibial tendon. Foot Ankle Clin. 1997;2:275-9.

  40. Gould JS, Nicholson BG. Flexor tendon injuries: acute repair and late reconstruction. In: Chapman MW, ed. Operative Orthopaedics. Philadelphia, Pa: Lippincott-Raven; 1988:. 1147-68.

  41. Graves SC, Stephenson K. The use of subtalar and triple arthrodeses in the treatment of posterior tibial tendon dysfunction. Foot Ankle Clin. 1997;2:319-28.

  42. Hansen ST Jr. Functional reconstruction of the foot and ankle. In: Functional Reconstruction of the Foot and Ankle. Baltimore, Md: Lippincott Williams & Wilkins; 2000:. 318-22.

  43. Harper MC. Talonavicular arthrodesis for the acquired flatfoot in the adult. Clin Orthop. Aug 1999;(365):65-8. [Medline].

  44. Helal B. Cobb repair for tibialis posterior tendon rupture. J Foot Surg. Jul-Aug 1990;29(4):349-52. [Medline].

  45. Helal B. Tibialis posterior tendon synovitis and rupture. Acta Orthop Belg. 1989;55(3):457-60. [Medline].

  46. Hintermann B, Valderrabano V, Kundert HP. Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int. Oct 1999;20(10):622-9. [Medline].

  47. Holmes GB Jr, Mann RA. Possible epidemiological factors associated with rupture of the posterior tibial tendon. Foot Ankle. Feb 1992;13(2):70-9. [Medline].

  48. Kitaoka HB, Patzer GL. Subtalar arthrodesis for posterior tibial tendon dysfunction and pes planus. Clin Orthop. Dec 1997;(345):187-94. [Medline].

  49. Komenda GA, Myerson MS, Biddinger KR. Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am. Nov 1996;78(11):1665-76. [Medline].

  50. Mann RA, Thompson FM. Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg Am. Apr 1985;67(4):556-61. [Medline].

  51. Marks RM. Posterior tibial tendon reconstruction with medial displacement calcaneal osteotomy. Foot Ankle Clinic. 1996;1:295-313.

  52. Momberger N, Morgan JM, Bachus KN, West JR. Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model. Foot Ankle Int. Sep 2000;21(9):730-5. [Medline].

  53. Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. Instr Course Lect. 1997;46:393-405. [Medline].

  54. Myerson MS, Corrigan J. Treatment of posterior tibial tendon dysfunction with flexor digitorum longus tendon transfer and calcaneal osteotomy. Orthopedics. May 1996;19(5):383-8. [Medline].

  55. Myerson MS, Corrigan J, Thompson F, Schon LC. Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency: a radiological investigation. Foot Ankle Int. Nov 1995;16(11):712-8. [Medline].

  56. O'Malley MJ, Deland JT, Lee KT. Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity: an in vitro study. Foot Ankle Int. Jul 1995;16(7):411-7. [Medline].

  57. Otis JC, Deland JT, Kenneally S, Chang V. Medial arch strain after medial displacement calcaneal osteotomy: an in vitro study. Foot Ankle Int. Apr 1999;20(4):222-6. [Medline].

  58. Pomeroy GC, Manoli A 2nd. A new operative approach for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report. Foot Ankle Int. Apr 1997;18(4):206-12. [Medline].

  59. Raines RA Jr, Brage ME. Evans osteotomy in the adult foot: an anatomic study of structures at risk. Foot Ankle Int. Nov 1998;19(11):743-7. [Medline].

  60. Resnick RB, Jahss MH, Choueka J, et al. Deltoid ligament forces after tibialis posterior tendon rupture: effects of triple arthrodesis and calcaneal displacement osteotomies. Foot Ankle Int. Jan 1995;16(1):14-20. [Medline].

  61. Sangeorzan BJ, Mosca V, Hansen ST Jr. Effect of calcaneal lengthening on relationships among the hindfoot, midfoot, and forefoot. Foot Ankle. Mar-Apr 1993;14(3):136-41. [Medline].

  62. Sferra JF, Rosenberg GA. Nonoperative treatment for posterior tibial tendon pathology. Foot Ankle Clin. 1997;2:261-73.

  63. Steffensmeier SJ, Saltzman CL, Berbaum KS, Brown TD. Effects of medial and lateral displacement calcaneal osteotomies on tibiotalar joint contact stresses. J Orthop Res. Nov 1996;14(6):980-5. [Medline].

  64. Toolan BC, Sangeorzan BJ, Hansen ST Jr. Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendo. J Bone Joint Surg Am. Nov 1999;81(11):1545-60. [Medline].

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.