Adult acquired flat foot deformity: The joint-preserving procedures in stage II tibialis posterior tendon dysfunction

NP Saragas,PNF Ferrao

doi:10.17159/2309-8309/2016/v15n1a4

Abstract

INTRODUCTION: The adult acquired flat foot (AAFF) deformity is a chronic debilitating condition commonly associated with dysfunction of the posterior tibial tendon (PTT). It is often missed unless it is associated with a generalised medical condition such as rheumatoid arthritis. Surgical management is indicated when conservative treatment fails. The joint-preserving procedures have evolved over the years and are preferred for the flexible, non-arthritic deformity. MATERIALS AND METHOD: Twenty-two patients were included in this prospective study. The mean age was 59.8 years with the majority being female. The average BMI was 28.7. The inclusion criterion was symptomatic AAFF deformity due to stage II PTT dysfunction RESULTS: Twenty patients were available for follow-up at one year. The mean AOFAS post-operative score of 89 was significantly improved from the pre-operative score of 42 (p value = <0.001). Likewise most of the radiographic parameters also improved significantly. The complication rate was very low CONCLUSION: This prospective study shows that the joint-preserving procedures for AAFF deformity due to stage II PTT dysfunction are an effective and preferable option to arthrodesis. There is a low complication rate with high patient satisfaction. A certain amount of training and expertise though, is required. Level 2 study.

Highlights

The adult acquired flat foot (AAFF) deformity is a chronic and progressive debilitating condition commonly associated with dysfunction of the posterior tibial tendon (PTT)
As the disease is characterised by medial longitudinal arch depression, talar depression and abduction of the forefoot, the appropriate radiographic parameters were measured as follows:[31,32] talonavicular coverage angle (TNCA); percentage talar head uncoverage(%TU); talo-first metatarsal angle (Meary’s)(TFMA); lateral talocalcaneal angle (LTCA); calcaneal pitch angle (CPA) and medial cuneiform to floor distance (MCFD) (Figure 2)
We present a series of 20 patients with stage II PTT dysfunction who underwent the joint-preserving procedures

Summary

Introduction

The adult acquired flat foot (AAFF) deformity is a chronic debilitating condition commonly associated with dysfunction of the posterior tibial tendon (PTT). It is often missed unless it is associated with a generalised medical condition such as rheumatoid arthritis. Conclusion: This prospective study shows that the joint-preserving procedures for AAFF deformity due to stage II PTT dysfunction are an effective and preferable option to arthrodesis. The adult acquired flat foot (AAFF) deformity is a chronic and progressive debilitating condition commonly associated with dysfunction of the posterior tibial tendon (PTT). In later stages arthritic changes can develop in the hindfoot joints.[1] This leads to a painful pes planus deformity and, with pathological changes in the deltoid ligament, associated ankle arthritis. Kulowski initially described tibialis posterior tendinitis in 1936.4 It was not until 1983, that Johnson discussed the condition in detail.[3]

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Discussion

Conclusion