Abstract
Pes planus deformity, whether associated with an accessory navicular syndrome or an adult-acquired flatfoot deformity, is a major source of disability across a broad spectrum of patients. Posterior tibial tendon dysfunction (PTTD) is the most common etiology for a progressive flatfoot in the adult population. Patients frequently present with a complaint of “ankle pain” demonstrating variable hindfoot alignment issues. In the acute onset, mild to moderate tenosynovitis without major deformity may be the typical finding. Without treatment, continued inflammatory changes lead to progressive degenerative changes, tendinosis, tearing, and elongation which result in structural changes. Johnson and Strom classified three stages of PTTD which can serve as a guide to treatment based on structural integrity and function of the tendon. Most frequently patients present with long-standing symptoms, and often the tendon has lost structural integrity, and surgical intervention is frequently necessary. Multiple options for joint preservation via tendon transfers and osteotomies exist which allow reduction of symptoms and enhanced function despite the fact that many of these procedures are not considered to be “arch restoring.” The postoperative recovery after surgical management of both the recalcitrant symptomatic PTTD and accessory navicular syndrome is a significant undertaking. It is crucial to assess the ability of each patient individually to successfully navigate the process and withstand several months of rehabilitation. While the initial recovery is approximately 12 weeks, time to maximal medical improvement may be as long as 12–18 months. The surgical outcomes are very good with appropriate patient selection, planning, and execution.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lee MS, Vanore JV, Thomas JL, et al. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg. 2005;44:78–113.
Hentges MJ, Moore KR, Catanzariti AR, Derner R. Procedure selection for the flexible adult acquired flatfoot deformity. Clin Podiatr Med Surg. 2014;31:363–79.
Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res. 1989;239:196–206.
Brodsky JW. Preliminary gait analysis results after posterior tibial tendon reconstruction:a prospective study. Foot Ankle Int. 2004;25:96–100.
Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. J Bone Joint Surg Am. 1996;78:780–92.
Weinraub GM, Heilala MA. Adult flatfoot/posterior tibial tendon dysfunction: outcomes analysis of surgical treatment utilizing an algorithmic approach. J Foot Ankle Surg. 2000;39(6):359–64.
Giza G, Cush G, Schon LC. The flexible flatfoot in the adult. Foot Ankle Clin. 2007;12:251–71.
Silvferskiold N. Reduction of the uncrossed two-joint muscles of the leg to one joint muscles in spastic conditions. Acta Chir Scand. 1924;56:315–30.
Younger AS, Sawatzky B, Dryden P. Radiographic assessment of adult flatfoot. Foot Ankle Int. 2005;26(10):820–5.
Mendicino RW, Catanzariti AR, John S, et al. Long leg calcaneal axial and hindfoot alignment radiographic views for frontal plane assessment. J Am Podiatr Med Assoc. 2008;98(1):75–8.
Lamm B, Mendicino R, Catanzariti A, et al. Static rearfoot alignment: a comparison of clinical and radiographic measures. J Am Podiatr Med Assoc. 2005;95(1):26–33.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Peterson, K.S., Dujela, M.D. (2019). Posterior Tibial Tendon Repair: Kidner, FDL Transfer, and Medial Displacement Calcaneal Osteotomy. In: Hyer, C., Berlet, G., Philbin, T., Bull, P., Prissel, M. (eds) Essential Foot and Ankle Surgical Techniques. Springer, Cham. https://doi.org/10.1007/978-3-030-14778-5_18
Download citation
DOI: https://doi.org/10.1007/978-3-030-14778-5_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-14777-8
Online ISBN: 978-3-030-14778-5
eBook Packages: MedicineMedicine (R0)