The Role of Biologics in the Treatment of Flatfoot

Abstract

Symptomatic adult-acquired flatfoot deformity (AAFD) is traditionally treated by realignment osteotomy and a tendon transfer. Despite high success rates for this procedure, prolonged recovery time and associated morbidities may lead many patients to shy away from having this type of surgery performed on them. Over the past decade, the use of biologics such as platelet-rich plasma and concentrated bone marrow aspirate concentrate has been gaining much popularity. The efficacy of these biologics to treat tendon pathologies is currently well supported in the literature. Therefore, when treating early AAFD with a functioning posterior tibial tendon, biological agents have the potential to enhance tendon healing and functional recovery. In this review we will be discussing the treatment algorithm which we currently use in our practice to manage AAFD. This will include the use of biologics with minimally invasive procedures, such as posterior tibial tendon tendoscopy and subtalar arthroereisis screws, which have the potential to address the biological and mechanical aspects of this common pathology. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.