Progressive Talipes Equinovalgus Due to Trauma or Degeneration of the Posterior Tibial Tendon and Medial Plantar Ligaments

Abstract

Summary Two patients with talipes equinovalgus secondary to laceration of the posterior tibial tendon have been presented. One patient with a seven year old lesion was managed by transfer of the flexor hallucis longus and reconstruction and advancement of the medial ligaments. The anatomic and functional result was essentially a normal foot. A second patient with a laceration of the posterior tibial tendon was managed by tendon transfer of the adjacent flexor digitorum longus without reconstruction of ligaments, because only five months had elapsed between injury and repair. In this patient also normal anatomic and physiologic relationships were re-established. Six patients with progressive talipes equinovalgus unrelated to specific trauma were managed by various operative procedures. Plication of the posterior tibial tendon was insufficient to eliminate pain completely and restore the longitudinal arch. Reinforcement by an adjacent flexor hallucis longus or flexor digitorum longus tendon alone was insufficient to re-establish a foot that was totally pain-free with an adequate longitudinal arch but did produce a better result than plication of the tendon alone. The evidence favors managing this kind of foot by plication and reinforcement of the medial plantar calcaneonavicular ligament, and by reinforcement of the diseased posterior tibial tendon with the flexor hallucis longus or flexor digitorum longus. If this treatment is done before degenerative joint changes occur, satisfactory function should be re-established and triple arthrodesis should be avoided.