Progressive collapsing foot deformity: clinical presentation, diagnosis, and management options

Abstract

Progressive collapsing foot deformity (PCFD) is a prevalent musculoskeletal disease that can cause significant deformity and disability. This review article aimed to overview the clinical presentation, diagnosis, and management options for PCFD. Google Scholar and PubMed were searched specifically for publications published up until May 2023 through several keywords. Inclusion criteria were articles on PCFD and articles published in English. The exclusion criteria were related to flexible flatfoot, vertical talus condition, and non-English articles. PCFD can present with various symptoms and signs, including elongation of the tibialis posterior tendon, hindfoot valgus deformity, forefoot abduction, weakness on the single-heel-rise test, and too-many-toes signs. The footprint assessment can be used easily and effectively to detect PCFD. Diagnosis of PCFD must be according to a thorough history taking, physical check-up, and appropriate imaging studies. Treatment options for PCFD range from conservative measures such as orthotic devices and physical therapy to more aggressive measures such as tendon transfers, arthroereisis, and implant-based reconstructions. The therapeutic plan should be individualized to the patient's requirements and comorbidities. Different surgical modalities are available to manage flat foot deformity, including arthroereisis, lateral column lengthening, medializing calcaneal osteotomy, dorsal opening wedge osteotomy, and cotton osteotomy. Each intervention has its benefits and disadvantages, and the most appropriate modality should be selected according to the kind and severity of the deformity, the patient's features and risk factors, and the surgeon's experience. Pre- and postoperative patient-reported outcomes measurement information system (PROMIS) scores can help to evaluate treatment outcomes.