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Medial calcaneus displacement osteotomy, FDL transfer to navicular
74%
856/1158
Lateral calcaneus displacement osteotomy, FDL transfer to navicular
7%
82/1158
Medial calcaneus displacement osteotomy, Peroneus longus to brevis transfer
13%
145/1158
Lateral calcaneus displacement osteotomy, Peroneus longus to brevis transfer
3%
40/1158
Split posterior tibial tendon transfer dorsally to the peroneus brevis
2%
21/1158
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Stage IIA adult acquired flatfoot deformity is commonly treated with a medial calcaneus displacement osteotomy and FDL transfer to the navicular. Inability to perform a single leg heel rise is one of the hallmark physical exam findings in a patient with posterior tibial tendon dysfunction (PTTD). Treatment consists of transfer of the FDL to the navicular, as it is synergistic to the posterior tibial tendon (PTT) and can augment function of a deficient PTT. Furthermore, a medial calcaneus displacement osteotomy should also be performed to correct hindfoot valgus. If an equinus contracture is also present, a tendoachilles lengthening or a gastroc recession should be performed based on the results of a Silfverskiöld test. Lastly, once the hind foot is corrected, the medial column should be evaluated. Many patients will have compensatory forefoot varus that should be corrected with a plantar flexion (dorsal opening wedge) osteotomy or 1st tarsometatarsal fusion to place the foot in an optimal position. Deland et al review adult acquired flatfoot deformity. They report that spring ligament failure occurs in conjunction with the failing posterior tibial tendon. They conclude that with progression of the pes planovalgus deformity, patients will experience deformity and attenuation along the entire medial longitudinal arch. Haddad et al review the management and controversies of adult acquired flat foot deformity. They report that Stage II deformity, in which the patient has swelling medially, an inability to do a single leg heel rise, and a passively correctable subtalar joint is the deformity most commonly requiring operative treatment. They conclude that treatment of this disease processes includes a medial calcaneal slide osteotomy, which realigns the hindfoot, improves the medial arch, and protects the FDL transfer. Incorrect Answers: Answer 2: The calcaneus osteotomy should be displaced medially to correct hindfoot valgus. Answer 3 and 4: Peroneus longus to brevis transfer may be utilized as part of the treatment for a cavovarus foot, not pes planovalgus. Answer 5: Split posterior tibial tendon transfer is used to correct spastic equinovarus deformities.
4.6
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