Medializing Calcaneal Osteotomy (MCO) and FDL Transfer as Therapy for Acquired Flat Foot

Abstract

Category: Hindfoot Introduction/Purpose: MCO and FDL Transfer is established for grade II PTTD. The study shows a comparison of one-year and intermediate-term results. Methods: Thirty-eight patients (40 feet) with an average age of 58 years (36-75) were operated for a grade II tibialis posterior tendon insuffiency between january 2005 and december 2008. The patients were seen pre-operatively, one year and an average of 98 months (84 -120) post-operatively to assess the following parameters: AOFAS Score, VAS Score for pain (0-10), FAOS Score. Foot x-rays in full weightbearing position (dorsoplantar and lateral) were done at every visit in order to assess the following parameters: tarsometatarsal I angle on the dorsoplantar and lateral view, talo-navicular coverage angle on the dorsoplantar view, talo-calcaneal angle, calcaneal pitch angle and medial cuneiforme height on the lateral view. Results: The AOFAS hindfoot score improved from 46.4 to 89.5 points 1-year postoperatively und decreased to 87.8 points at the last follow-up. VAS for pain decreased from 6.6 pre-operatively to 1.1 at the one year follow-up and increased to 1.5 at the last follow-up. The FAOS with its subscores showed following results (pre-op, one-year post-op, final follow-up): pain subscore: 64.1, 94.3, 92.1; symptoms subscore: 80.5, 96.7, 97.3; ADL(function daily living): 67.1, 89.4, 85.3; Quality of life: 25.0, 83.6, 84.1. All clinical Scores showed a significant improvement from pre-operatively to one year post-operatively and no further significant change from one year post-operatively to final follow-up.All radiologic parameters except for the talo-navicular coverage angle improved and stayed without significant changes over time. Following complications were seen: one recurrence, two patients with irritation of the sural nerve, one patient with hypesthesia of the big toe. In ten patients the screws had to be removed. Conclusion: Flexor digitorum longus transfer together with medializing calcaneal osteotomy provides excellent results for the therapy of acquired flat foot deformity. The clinical and radiologic results improved from pre-operatively to one-year post- operatively and did not worsen over time.