Reconstruction of the Stage IIA Adult-acquired Flatfoot Deformity

Abstract

Stage IIA adult-acquired flatfoot deformity is defined by a characteristic collapse of the medial arch with passively correctible hindfoot valgus, limited forefoot abduction, and forefoot varus deformities. Operative treatment for symptomatic patients who fail conservative therapy is determined by the deformities present, but can include a medializing calcaneal osteotomy, flexor digitorum tendon transfer to the navicular, gastrocnemius recession, repair of the posterior tibial tendon, and spring ligament as well as medial column procedures including a Cotton osteotomy or first tarsometatarsal fusion. These procedures have been shown to restore alignment radiographically and to improve both pain and quality of life. In this article, we describe our technique for reconstruction of the stage IIA flatfoot and address common concerns that occur both intraoperatively and postoperatively.