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      Treatment of Stage II Posterior Tibial Tendon Deficiency With Flexor Digitorum Longus Tendon Transfer and Calcaneal Osteotomy

      1 , 1 , 1
      Foot & Ankle International
      SAGE Publications

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          Abstract

          To assess the efficacy of surgical correction of stage II tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular, the authors retrospectively reviewed results of treatment of stage II posterior tibial tendon deficiency in 129 patients for whom surgery was performed between 1990 and 1997.

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          Most cited references25

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          Effect of calcaneal lengthening on relationships among the hindfoot, midfoot, and forefoot.

          To better understand the bony component of pes planus and the means by which the Evans calcaneal lengthening corrects them, we studied the standing radiographs of seven adult patients who had undergone calcaneal lengthening to treat symptomatic pes planus. Weightbearing AP and lateral views done preoperatively and postoperatively were used for the study. For each set of films, the following parameters were measured: on the lateral view; overall length of the calcaneus, lateral talometatarsal angle, lateral talocalcaneal angle, and the calcaneal pitch angle; and on the dorsoplantar view, the talometatarsal and talocalcaneal angle. In addition, the relative coverage of the talus by the navicular was described by an angular measurement based on the relationship of the center of the talus to the center of the navicular. The average improvements in lateral talocalcaneal angle (a reflection of hindfoot valgus) was 6.4 degrees when the long axis of the calcaneus was used and 6.8 degrees when the inferior surface of the calcaneous was used for the measurement. The lateral talometatarsal angle improved an average 11.3 degrees (from an average of 19.7 degrees to 8.4 degrees). The dorsoplantar talometatarsal angle (a measure of forefoot adduction/abduction) improved 15.8 degrees (preoperative average 26.8 degrees, postoperative average 11 degrees). The calcaneal pitch angle improved an average 10.8 degrees (preoperative average 3.2 degrees, postoperative average 14 degrees). The relationship between the talus and navicular was defined by an angular measurement based on the center of each articular surface before and after correction using this measurement. An average improvement of 26 degrees occurred in the alignment of these two articular surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Rupture of the posterior tibial tendon causing flat foot. Surgical treatment.

            Rupture of the posterior tibial tendon results in a progressive, painful flat-foot deformity. Other physical findings are an inability to invert the heel on tip-toe standing and loss of inversion power. In this study we report on seventeen patients with this condition who were surgically treated with a transfer of the flexor digitorum longus tendon into the navicular or an advancement of the posterior tibial tendon. Follow-up results were excellent in twelve, good in one, fair in three, and poor in one patient. Arthrodesis of the talonavicular and calcaneocuboid joints was subsequently done for the patient with the poor result.
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              Isolated subtalar arthrodesis.

              Forty-eight isolated subtalar arthrodeses in 44 patients with an average follow-up of 59.5 months were retrospectively reviewed. Original diagnoses included talocalcaneal coalition, healed calcaneal fracture with subtalar arthrosis, acquired flatfoot because of posterior tibial tendon dysfunction, degenerative subtalar arthrosis, subtalar instability, and psoriatic arthritis. Ninety-three percent of patients were very satisfied or satisfied with their treatment. Pain and function improved significantly, and the American Orthopaedic Foot and Ankle Society ankle-hindfoot score at follow-up was 89. There were six unsatisfactory results: three feet had calcaneal fractures and three were malpositioned. Union was achieved in all cases. Transverse tarsal motion was diminished by 40%, dorsiflexion by 30%, and plantarflexion by 9%. There was a 36% and 41% incidence of mild radiographic progression of arthrosis in the ankle and transverse tarsal joint, respectively. Isolated subtalar arthrodesis provided a highly successful result in the disease presented, and this study provides support for the use of a selected hindfoot fusion procedure for specific indications.
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                Author and article information

                Journal
                Foot & Ankle International
                Foot Ankle Int.
                SAGE Publications
                1071-1007
                1944-7876
                June 28 2016
                July 2004
                June 28 2016
                July 2004
                : 25
                : 7
                : 445-450
                Affiliations
                [1 ]Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, MD
                Article
                10.1177/107110070402500701
                15319100
                13647da9-f5bd-4c47-8cee-afc722ce3c5e
                © 2004

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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