Progressive Collapsing Foot Deformity – Flatfoot

Deland, Jonathan T.

doi:10.1007/978-3-030-95738-4_24

Cited by 3 publications

(3 citation statements)

References 42 publications

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“…Therefore, for the present time we believe it is safest to state that SLR contributes to correction of deformity but that the bony procedure must contribute to 50% or somewhat more of the intraoperative correction of the TN joint as was specified in this study. 13,23 In conclusion, this study revealed favorable medium-to long-term outcomes as well as maintenance of the correction following a tibiospring ligament complex reconstruction using allograft tendon augmentation in addition to other corrective procedures for the surgical treatment of PCFD with severe abduction deformity. Because of the growing body of evidence regarding the potential of excess stiffness following LCL, an interesting remaining question in our minds is whether it is reasonable to use an SLR to lessen the amount of LCL needed, as long as 50% of the correction is achieved by the bony procedure.…”

Section: Discussionmentioning

confidence: 63%

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Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

et al. 2023

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Background: Spring ligament reconstruction (SLR) has been suggested as an adjunct to other reconstructive procedures to potentially avoid talonavicular joint fusion in progressive collapsing foot deformity (PCFD) with severe abduction deformity. Most clinical reports present short-term follow-up data and a small number of patients. The purpose of this study was to examine the medium- to long-term outcomes of an SLR using allograft tendon augmentation as part of PCFD surgical reconstruction. This study to our knowledge represents the largest number of patients and the longest follow-up to date. Methods: This study retrospectively reviewed 26 patients (27 feet, mean age of 61.4 years) who underwent SLR with allograft tendon as part of PCFD reconstruction. The mean follow-up of the cohort was 8 years (range, 5-13.4). Radiographic evaluation consisted of 5 parameters including talonavicular coverage angle (TNC), with the maintenance of correction being evaluated by comparing parameters from the early postoperative period (mean: 11.6 months, range, 8-17) to final follow-up. Foot and Ankle Outcome Score (FAOS) and patient satisfaction questionnaires were collected at final follow-up. Conversion to talonavicular or subtalar fusion was considered as a failure. Results: Final radiographs demonstrated successful abduction correction, with the mean TNC improving from 43.7 degrees preoperatively to 14.1 degrees postoperatively (P < .0001). All other radiographic parameters improved significantly and exhibited maintenance of the correction. All FAOS subscales showed significant improvement. Responses to the satisfaction questionnaire were received from all except 1 patient, of whom 88.5% (23/26) were satisfied with the results, 96.2% (25/26) would undergo the surgery again, and 88.5% (23/26) would recommend the surgery. Eight feet (29.6%) required painful hardware removal and 1 (3.7%) developed nonunion of the lateral column lengthening osteotomy. No patient required conversion to talonavicular or subtalar fusion. Conclusion: This study demonstrates favorable medium- to long-term outcomes following PCFD reconstruction including an SLR with allograft tendon augmentation. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

et al. 2023

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“…23 The failure of the ligaments surrounding, or within, the subtalar joint has been well documented in previous PCFD publications. [5][6][7]16,21 The spring ligament and talocalcaneal interosseous ligament are perhaps the two that have garnered the most interest. 5,7 Imaging studies using magnetic resonance imaging (MRI) suggest that their involvement may reflect the severity of the PCFD deformity.…”

Section: Introductionmentioning

confidence: 99%

Cervical Ligament Insufficiency in Progressive Collapsing Foot Deformity: It May Be More Important Than We Know

Kim,

Mizher,

Cororaton

et al. 2023

Foot Ankle Int.

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Background: Subluxation at the subtalar joint is one of the major radiographic features that characterize progressive collapsing foot deformity (PCFD). Although it is recognized that the cervical ligament plays an important function in maintaining the subtalar joint’s stability, its role and involvement in PCFD is largely unknown. The purpose of this study was to assess the prevalence of cervical ligament insufficiency in patients with PCFD and to establish if the degree of its pathology changes with increasing axial plane deformity. Methods: This study retrospectively reviewed magnetic resonance imaging (MRI) of 78 PCFD patients and age- and gender-matched controls. The structures evaluated were the cervical, spring, and talocalcaneal interosseous ligaments. Structural derangement was graded on a 5-part scale (0-4), with grade 0 being normal and grade 4 indicating a tear of greater than 50% of the cross-sectional area. Plain radiographic parameters (talonavicular coverage angle [TNC], lateral talo–first metatarsal [Meary] angle, calcaneal pitch, and hindfoot moment arm) as well as axial plane orientation of the talus (TM-Tal) and calcaneus (TM-Calc) relative to the transmalleolar axis and talocalcaneal subluxation (Diff Calc-Tal) were correlated with the cervical ligament MRI grading system. Results: The overall distribution of the degree of cervical ligament involvement was significantly different between the PCFD and control groups ( P < .001). MRI evidence of a tear in the cervical ligament was identified in 47 of 78 (60.3%) feet in the PCFD group, which was significantly higher than the control group (10.9%) and comparable to that of superomedial spring (43.6%) and talocalcaneal interosseous (44.9%) ligaments. Univariate ordinal logistic regression modeling demonstrated a predictive ability of TM-Calc (odds ratio [OR] 1.17, 95% CI 1.06-1.30, P = .004), Diff Calc-Tal (OR 1.15, 95% CI 1.06-1.26, P = .002), TNC (OR 1.08, 95% CI 1.03-1.13, P = .003), and Meary angle (OR 1.05, 95% CI 1.02-1.10, P = .006) in determining higher cervical ligament grade on MRI. Conclusion: This study found that cervical ligament insufficiency is more often than not associated with PCFD, and that an increasing axial plane deformity appears to be associated with a greater degree of insufficiency. Level of Evidence: Level III, case-control study.

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Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures

Kim

Rajan

Henry

et al. 2023

Arch Orthop Trauma Surg

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Progressive Collapsing Foot Deformity – Flatfoot

Cited by 3 publications

References 42 publications

Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

Cervical Ligament Insufficiency in Progressive Collapsing Foot Deformity: It May Be More Important Than We Know

Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures

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