Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of tibialis posterior

Abstract

The treatment of acquired flat foot secondary to dysfunction of the posterior tibial tendon (PTT) of stage II, as classified by Johnson and Strom, remains controversial. Joint sparing and soft-tissue reconstructive procedures give good early results, but few studies describe those in the medium-term. We studied prospectively the outcome of surgery in 51 patients with classical stage-II dysfunction of the PTT treated by a medial displacement calcaneal osteotomy and transfer of the tendon of flexor digitorum longus. We reviewed 44 patients with a mean follow-up of 51 months (38 to 62). The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot rating scale improved from 48.8 before operation to 88.5 at follow-up. The operation failed in two patients who later had a calcaneocuboid fusion. The outcome in 43 patients was rated as good to excellent for pain and function, and in 36 good to excellent for alignment. There were no poor results.

Correction and Prevention of Deformity in Type II Tibialis Posterior Dysfunction

“…The AOFAS hindfoot scores improved from 52.2 before surgery to 89 postoperatively, comparable with other series [13] and other alternatives [17,18,25]. Although not validated, our simple patient satisfaction score suggests high patient-rated satisfaction and the longer-term clinical assessment confirmed there was no progression of the deformity.…”

“…We have simply mentioned them in the discussion for completeness. However, the AOFAS hindfoot score is validated and the results achieved are comparable with others using the same technique [13] and FDL transfer with os calcis osteotomy [17,18,25] (Table 5). Finally, there were some reservations about the ''extensive'' surgical incisions.…”

“…We believe that addressing the condition before this later phase is reached would be advantageous, but this would have to be confirmed by further studies. The principle alternative to a Cobb reconstruction in early Stage II TPD is a flexor digitorum longus transfer (FDL) usually associated with a calcaneal osteotomy [16][17][18]25]. This technique is widely reported in North America, Australasia, and Europe [7,[16][17][18]25], but we believe it is a weak replacement muscle [13].…”

Adult acquired flexible flatfoot, treated by calcaneo-cuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: A prospective outcome study of 20 patients

“…An improvement of the AOFAS hindfoot score from 48 before operation to 84 at follow-up was found in 32 patients treated with medial displacement osteotomy and FDL transfer (Myerson et al 1996). Wacker et al (2002) reported that 43 of 44 patients had excellent or good outcome regarding pain and 36 had good alignment, using the same procedure. Guyton et al (2001) reviewed the results of 26 patients who had undergone this procedure, also for stage 2 (Johnson and Strom 1989) posterior tendon dysfunction, at an average of 32 months and concluded that this procedure provides good medium-term functional and symptomatic results.…”

Die Operation des erworbenen Plattfu�es

“…Table 1 Ankle-hindfoot scale (100 points total) [6]. Wacker et al [10] präsentierten die Resultate von 51 Patienten, die aufgrund einer Dysfunktion der Sehne des Musculus tibialis posterior, Stadium II, mit einer medialisierenden Kalkaneusosteotomie und einer Verlagerung der Sehne des Musculus flexor digitorum longus behandelt worden waren. 44 Patienten mit einem durchschnittlichen Nachuntersuchungszeitraum von 51 (38-62) Monaten konnten beurteilt werden.…”