Aim. We report the results of Cobb I procedure and Rose calcaneal osteotomy for stage II posterior tibial dysfunction in a consecutive series of thirty patients. Methods. These patients were reviewed prospectively after average of 30 months (range: 12-92 months). An experienced independent, biomechanics specialist carried out the ultrasound examination to assess dynamic function of the posterior tibial tendon at final follow-up. Results. Twenty-eight patients were available for final follow-up. Two patients died of unrelated causes. Mean age was 60 years (range: 40-81 years). Average AOFAS score improved from 53.6 pre-operatively to 89.8 at final follow-up. Twenty-five (89%) patients were able to perform single heel raise. Six (22%) were using some form of orthotics at final follow-up. All calcaneal osteotomies united. On ultrasound examination, the posterior tibial tendon was intact in all patients and it was found to be mobile in twenty-six (93%) patients. There was one superficial wound infection and two prominent screws were removed. Three patients had subtalar joint arthritis. The surgical intervention improved the quality of life in all but two patients and only two patients were not satisfied with the surgery. Conclusion. These results suggest that a combination of Cobb I procedure and Rose Calcaneal osteotomy is a safe, effective, reliable and attractive option for the treatment of stage II posterior tibial tendon dysfunction, which provides dynamic function of posterior tibial tendon without sacrificing the primary function of long flexor tendons in foot and ankle

Background. Ankle fractures represent an increasing workload, particularly in the elderly female population. The posterior tibial tendon is exposed to injury during displaced medial malleolar fractures. Posterior tibial tendon dysfunction delays rehabilitation and results in significant morbidity and is most prevalent in women over 40. Objective. To ascertain whether posterior tibial tendon should be routinely explored in displaced medial malleolar fractures and consequently should post-operative rehabilitation of ankle fractures be modified. Intra-operative assessment of the tendon may help with this diagnosis and consequently alter post-operative rehabilitation. Method. We performed a prospective case series of 25 patients with displaced medial malleolar ankle fractures admitted to the Royal Victoria Hospital Belfast between August and November 2009. The admission notes were then checked for any previous injuries and the initial reduction was assessed radiologically. At the time of surgery the primary operator explored the posterior tibial tendon and assessed the tendon for damage using the following scale: nil, bruising, superficial, partial tear, complete tear. Results. The average age was 58. The majority of injuries were Weber B (20/25), bimalleolar (19/25), had an initial satisfactory reduction (19/25) and had the surgery performed by SPR/STR (22/25). The mechanism of injury was reported as mainly supination-external rotation (13/25). Eight patients were reported as having superficial damage and one with a partial rupture. Of note all patients included under the age of forty were reported as having no damage to posterior tibial tendon. Conclusion. This study does not support the routine exploration of the posterior tibial tendon in displaced medial malleolar fractures. However, the study would advocate an altered post-op regime for at risk groups for posterior tibial dysfunction