Flexor digitorum longus transfer and medial displacement
calcaneal osteotomy is a well-recognised form of treatment for stage
II posterior tibial tendon dysfunction. Although excellent short-
and medium-term results have been reported, the long-term outcome
is unknown. We reviewed the clinical outcome of 31 patients with
a symptomatic flexible flat-foot deformity who underwent this procedure
between 1994 and 1996. There were 21 women and ten men with a mean
age of 54.3 years (42 to 70). The mean follow-up was 15.2 years
(11.4 to 16.5). All scores improved significantly (p <
0.001).
The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved
from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up.
The mean pain component improved from 12.3 to 35.2 (20 to 40). The
mean function score improved from 35.2 to 45.6 (30 to 50). The mean
visual analogue score for pain improved from 7.3 to 1.3 (0 to 6).
The mean Short Form-36 physical component score was 40.6 ( Cite this article:
Distraction bone-block arthrodesis has been advocated for the treatment of the late sequelae of fracture of the os calcis. Between 1997 and 2003 we studied a consecutive series of 17 patients who had The mean American Orthopaedic Foot and Ankle Society hindfoot score improved from 29.8 (13 to 48) to 77.8 (48 to 94) (Student’s These results suggest that anterior impingement need not to be a significant problem after subtalar arthrodesis for fracture of the os calcis, even when the loss of talocalcaneal height is marked. We recommend
The treatment of acquired flat foot secondary to dysfunction of the posterior tibial tendon (PTT) of stage II, as classified by Johnson and Strom, remains controversial. Joint sparing and soft-tissue reconstructive procedures give good early results, but few studies describe those in the medium-term. We studied prospectively the outcome of surgery in 51 patients with classical stage-II dysfunction of the PTT treated by a medial displacement calcaneal osteotomy and transfer of the tendon of flexor digitorum longus. We reviewed 44 patients with a mean follow-up of 51 months (38 to 62). The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot rating scale improved from 48.8 before operation to 88.5 at follow-up. The operation failed in two patients who later had a calcaneocuboid fusion. The outcome in 43 patients was rated as good to excellent for pain and function, and in 36 good to excellent for alignment. There were no poor results.
Acquired flatfoot deformity after injury is usually due to partial or complete tearing of the tendon of tibialis posterior, with secondary failure of the other structures which maintain the medial longitudinal arch. We describe a patient in whom the rupture of the plantar calcaneonavicular (spring) ligament resulted in a clinical picture similar to that of rupture of the tendon of tibialis posterior. Operative repair of the ligament and transfer of the tendon of flexor digitorum gave an excellent result at four years with the patient returning to full sporting activities.