Posterior Tibialis Tendon Dysfunction: Preliminary Report / 대한정형외과학회잡지

PURPOSE: Posterior tibialis tendon dysfunction (PTTD) is one of the most common causes of acquired flatfoot deformity in western countries. But it was known that they were very rare in eastern countries. So we want to report the clinical features and outcomes of 12 patients with PTTD. MATERIALS AND METHODS: We evaluated the results of 12 patients using clinical features and results from March 2000 to January 2007 and mean follow up periods is 32 months. RESULTS: Average age was 45 years, 8 of 12 patients were female, 2 patient with hypertension and 1 with rheumatoid arthritis. 5 patients were overweighted and 5 patients were obese. 4 patients has a history of last trauma. 4 patients experienced progression of flatfoot. On behalf of Johnson and Strom classifications 6 cases were grade I, 4 cases were grade II, grade III, and grade IV was 1 case, relatively. As a treatment we used tenosynovectomy for 3 cases of grade I, additional FDL transfer was done for 2 cases of grade I and 2 cases of grade II. For other 2 patients of grade II flexor digitorum longus transfer and Medial displacement calcaneal osteotomy was done. Pathologic findings of tendon showed degenerative tendinitis. Lastly conservative treatment group was 3 cases of grade I, III, IV each. Average preoperative and postoperative American Orthopedic Foot and Ankle Society's hindfoot/ankle scoreFAS score was 58 and 90. Initial and follow up AOFAS scores of the conservative group was 38 and 57, relatively. CONCLUSION: As a cause of acquired flatfoot in adult, PTTD is not a rare disease any more in Korea. To prevent the disability and progression of flatfoot, careful clinical evaluation and proper treatment is important.

Medial Displacement Calcaneal Osteotomy: Biomechanical Effect on Calcaneal Inversion / 대한정형외과학회잡지

PURPOSE: This study was performed to investigate the dynamic effect of medial displacement calcaneal osteotomy (MCO) on the calcaneal inversion. MATERIALS AND METHODS: 10 fresh-frozen, intact cadaver foot-ankle specimens were tested, using a custom loading apparatus at an orientation consistent with the early heel rise portion (40%) of the gait cycle. Calcaneal inversion was measured with identical ground reac-tion force and tendon force, before and after MCO. RESULTS: Calcaneal inversion was 2.1+/-2.4degrees in the pre-osteotomy condition and 3.7+/-3.1degrees after MCO. Calcaneal plantar flexion was 7.1+/-0.7degrees in the pre-osteotomy condition and 8.8+/-1.8degrees after MCO. Increases of calcaneal inversion and flexion were significant (intact vs. MCO), (p< 0.05). CONCLUSION: The inversion capability of the Achilles tendon was enhanced by lengthening its moment arm when its insertion was displaced medially following MCO. MCO, therefore, could compensate for the weaker inverting power of the transferred toe flexor, when treating stage II posterior tibial tendon insufficiency.