Surgical Treatment of Acquired Flatfoot Deformity: What is the State of Practice among Academic Foot and Ankle Surgeons in 2002?

Hiller, Luke; Pinney, Stephen J.

doi:10.1177/107110070302400909

Cited by 124 publications

(93 citation statements)

References 11 publications

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“…1 Many have a history of diabetes, hypertension, and obesity, 2 so the incidence of flatfoot may be on the rise. The treatment of pes planus is not well-standardized 3,4 and may involve immobilization, orthoses, and surgical correction. [2][3][4][5] Flatfoot deformity involves loss of the medial longitudinal arch of the foot, in addition to forefoot abduction and hindfoot eversion.…”

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confidence: 99%

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Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Blackman

Blevins

Sangeorzan

et al. 2009

Journal Orthopaedic Research

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Flatfoot deformity is characterized by loss of the medial longitudinal arch, forefoot abduction, hindfoot eversion, and often Achilles tendon contracture. Our objectives were to validate a cadaveric flatfoot model that involves selective ligament attenuation and to determine if Achilles tendon overpull is associated with increased pes planus severity. We measured the three-dimensional (3D) orientation of the bones of interest in the unloaded, loaded, and Achilles tendon overpull conditions. A flatfoot model was created by attenuating ligaments involved in the pes planus deformity followed by cyclic axial loading, and bone orientations were acquired in the three conditions. Significant differences seen between normal feet and flat feet were consistent with those seen with the pes planus deformity. The first metatarsal dorsiflexed and abducted relative to the talus. The navicular abducted relative to the talus. The calcaneus everted relative to the tibia. The talus plantar flexed and adducted. Achilles overpull resulted in first metatarsal-to-talus dorsiflexion and navicular-to-talus abduction. Thus, selective ligament attenuation followed by cyclic axial loading can create a cadaveric flatfoot model consistent with the in vivo deformity. Longitudinal arch depression, hindfoot eversion, talonavicular joint abduction, forefoot abduction, and talar plantar flexion were seen. Simulated Achilles tendon contracture increased the severity of the deformity, particularly in arch depression and forefoot abduction.

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confidence: 99%

“…The treatment of pes planus is not well-standardized 3,4 and may involve immobilization, orthoses, and surgical correction. [2][3][4][5] Flatfoot deformity involves loss of the medial longitudinal arch of the foot, in addition to forefoot abduction and hindfoot eversion. 5,6 Many severe or longstanding cases are associated with Achilles tendon contracture.…”

mentioning

confidence: 99%

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Blackman

Blevins

Sangeorzan

et al. 2009

Journal Orthopaedic Research

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“…This stronger transfer and its anatomic position give greater opportunity for correction of peritalar deformity, including the apparent nonweightbearing forefoot supination [13]. Lateral column lengthening would be reserved for more severe deformities [23,24] with arthrodeses for those that had become fixed [7,19].…”

Section: Discussionmentioning

confidence: 99%

“…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]. Recently, the addition of arthroeresis has been advocated to further enhance the correction of deformity [24].…”

Section: Introductionmentioning

confidence: 99%

Correction and Prevention of Deformity in Type II Tibialis Posterior Dysfunction

Parsons

Naim

Richards

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Cobb described a method of reconstruction in Johnson and Strom Type II tibialis posterior dysfunction (TPD) using a split tibialis anterior musculotendinous graft. We assessed patient function and satisfaction after a modified Cobb reconstruction in a group of patients with a narrow spectrum of dysfunction, examined a modification of the Johnson and Strom classification to emphasize severity of deformity, and assessed the ability of the technique to prevent subsequent fixed deformity. We prospectively followed 32 patients managed by this technique and a translational os calcis osteotomy with early flexible deformity after failed conservative treatment. There were 28 women and four men with unilateral disease. The average followup was 5.1 years. Staging was confirmed clinically and with imaging. The modified surgery involved a bone tunnel in the navicular rather than the medial cuneiform with plaster for 8 weeks followed by orthotics and physiotherapy.

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“…The treatment for this stage is controversial in terms of adding lateral column lengthening (LCL) to the medializing calcaneal osteotomy, FDL transfer, gastrocnemius recession, and medial column procedures [38,39]. The purpose of the LCL is to correct talonavicular joint abduction and to increase the foot arch.…”

Section: Stage Iiamentioning

confidence: 99%

Approach and treatment of the adult acquired flatfoot deformity

Vulcano

Deland

Ellis

2013

Curr Rev Musculoskelet Med

101

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Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.

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Surgical Treatment of Acquired Flatfoot Deformity: What is the State of Practice among Academic Foot and Ankle Surgeons in 2002?

Abstract: There is a wide variation in the approach to surgical treatment of stage II acquired adult flatfoot deformity among academic foot and ankle surgeons. Most surgeons employed a combination of bony and soft-tissue procedures that preserved the subtalar and talonavicular joints.

Cited by 124 publications

References 11 publications

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Correction and Prevention of Deformity in Type II Tibialis Posterior Dysfunction

Approach and treatment of the adult acquired flatfoot deformity

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