Local Navicular Graft for Use in Lateral Column Lengthening in the Surgical Treatment of Stage II Posterior Tibial Tendon Disease

Abstract

The treatment of Johnson stage II posterior tibial (PT) tendon disease has been well described. Previous techniques for completing a lateral column lengthening for correction of forefoot abduction and supination deformity, as part of a multilevel surgical correction, include tricortical bone graft. Both autogenous and allograft tricortical bone wedges have been shown to successfully achieve correction and maintain the correction with the Evans lateral column lengthening technique. Several patients who require surgical management of their pes planovalgus deformity also have either an accessory navicular or a large medial navicular. Currently described techniques discard this tissue in the resection of the PT tendon and the transfer of the flexor digitorum longus. In this study, 10 of the 68 patients who required surgical management of their stage II PT tendon disease over a period of 24 months had local autograft harvested from the navicular used in the lateral column lengthening. In addition, they all underwent flexor digitorum longus to PT tendon transfer, medializing calcaneal osteotomies, and gastrocnemius recessions, in addition to their lateral column lengthening. Preoperative and postoperative radiographs were evaluated for healing of the calcaneal osteotomy and for correction of deformity. In addition, the American Orthopaedic Foot and Ankle Society’s hindfoot rating scale was applied to all patients preoperatively and at 6 months after surgery. Radiographs revealed that all osteotomy sites with local navicular graft healed by 8 weeks and that American Orthopaedic Foot and Ankle Society scores improved from 51 to 93 points, which compares favorably with scores from patients managed with iliac crest autograft or allograft bone wedges. A review of our data reveals that nearly 1 in 5 patients who present for reconstructive surgery for their stage II PT tendon disease can successfully have autograft used for lateral column lengthening osteotomy with predictable results.