Posterior Tibial Tendon Insufficiency Results at Different Stages

Abstract

The results of surgical treatment of posterior tibial tendon insufficiency (PTTI) may be different at different stages of the disease. No single study has compared the results at different stages. This comparison can be helpful to the patient and physician if the patient asks "What if I wait and the disease progresses, how will my results be different?" A preliminary study comparing results for stage IIa, stage IIb (advanced stage II), and stage III was performed followed by a larger study comparing IIa and IIb with 26 and 22 patients, respectively. American Orthopaedic Foot and Ankle Society (AOFAS) outcome scores as well as radiographs and functional questions were used. Nearly all patients, regardless of stage, felt they were helped by surgical treatment. However, the lowest AOFAS score was in stage III, the most advanced stage investigated in this study. In comparing stage IIa and IIb patients, stage IIb patients had a statistically higher incidence of lateral discomfort. Although statistically significant differences were not found in all comparisons, this study suggests that the results of surgical treatment for PTTI declines with increasing stage or severity of disease.

Approach and treatment of the adult acquired flatfoot deformity

“…Four stages of the disease have been described [1,[6][7][8]. Stage I presents without arch collapse, but frequently with a relatively low lying arch that has been present since childhood.…”

“…The latter is flexible and characteristically correctible through passive inversion at the talonavicular joint and hindfoot. Deland et al [7] have further subdivided stage II AAFD in stage IIa and stage IIb. Stage IIa is a mild to moderate flexible deformity with minimal abduction through the talonavicular joint as evidenced by less than 30 % talonavicular uncoverage on a standing AP radiograph of the foot (Fig.…”

“…7a and b). As successful as these procedures have proved to be in terms of foot realignment [40][41][42], the most frequently observed complication is lateral foot discomfort affecting up to 45 % of patients in 1 study [7]. Pain and discomfort may arise as a consequence of lateral overload in the hindfoot and possibly the forefoot [41, 43••, 44, 45].…”

Autograft and Allograft Unite Similarly in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

“…Stage II has been further subdivided into mild (<30% talonavicular uncoverage, IIa) and severe (>30% talonavicular uncoverage, IIb) [8,24]. This subdivision is based on the amount of forefoot abduction manifested through the talonavicular joint as present on an anteroposterior, weight-bearing radiograph [9]. Lateral column lengthening (LCL), originally described by Evans [14], is used to specifically address the forefoot abduction that occurs in patients with stage IIb flatfoot deformity.…”

Adult Acguired Flatfoot Deformity (Review)

“…При этом также часто наблюдается недостаточность межкостных связок. Стадия ІІb представляет собой мягкую деформацию [15]. Чаще всего от-мечается более 30% недопокрытия в таранно-ладьевидном суставе.…”