Operative Treatment of Acquired Adult Flatfoot / 대한족부족관절학회지

Acquired adult flatfoot deformity is characterized by flattening of the medial longitudinal arch and dysfunction of the posteromedial soft tissues, including the posterior tibial tendon. When the non-operative treatment fails to result in improvement of symptoms, surgery should be considered. Operative techniques include flexor digitorum longus tendon transfer, calcaneal medial slide osteotomy, lateral column lengthening, and arthrodesis of the hindfoot. The principle of correcting the deformity while avoiding overcorrection and excessive stiffness is important in achievement of good outcomes in these patients.

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.