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

Myerson, Mark S.; Badekas, Athanasios; Schon, Lew C.

doi:10.1177/107110070402500701

Cited by 271 publications

(262 citation statements)

References 37 publications

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“…2 Por lo tanto, se ha recomendado la sustitución del TTP por medio de la transferencia de tendones aunque eso no corrige la deformidad. 3 Debido a esto es necesario agregar una osteotomía.…”

Section: Introductionunclassified

“…3,4 Respecto al método de fijación de la osteotomía existen diferentes alternativas de fijación. El objetivo del trabajo es presentar los resultados radiográficos y clínicos del tratamiento de la insuficiencia del TTP Grado II y sus deformidades resultantes mediante osteotomía de desplazamiento medial del calcáneo fijada con placa escalonada y otros procedimientos.…”

Section: Introductionunclassified

“…2 Therefore, TTP replacement has been recommended by means of tendon transfer although this does not correct the deformity. 3 Because of this it is necessary to add an osteotomy. 2,4 The osteotomy by preference is the medialization of the posterior tuberosity of the calcaneus.…”

Section: Introductionmentioning

confidence: 99%

“…2,4 The osteotomy by preference is the medialization of the posterior tuberosity of the calcaneus. 3,4 Regarding the fixation method of the osteotomy, there are different fixation alternatives. The objective of this study was to present the radiographic and clinical results of the treatment of TTP grade II insufficiency and its resulting deformities by osteotomy of the medial displacement of the calcaneus fixed with stepped plaque and other procedures.…”

Section: Introductionmentioning

confidence: 99%

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Placa escalonada de calcáneo en insuficiencias del tibial posterior grado II. Serie de casos. Resultados radiológicos

Sini¹,

Navello²,

Mazzucchelli³

et al. 2017

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Por lo tanto, se ha recomendado la sustitución del TTP por medio de la transferencia de tendones aunque eso no corrige la deformidad.3 Debido a esto es necesario agregar una osteotomía.2,4 La osteotomía por preferencia es la medialización de la tuberosidad posterior del calcáneo. 3,4 Respecto al método de fijación de la osteotomía existen diferentes alternativas de fijación. El objetivo del trabajo es presentar los resultados radiográficos y clínicos del tratamiento de la insuficiencia del TTP Grado II y sus deformidades resultantes mediante osteotomía de desplazamiento medial del calcáneo fijada con placa escalonada y otros procedimientos. Desarrollo de los casosEntre el año 2013 y 2016, se incluyeron 11 pacientes 9 mujeres y 2 hombres. La edad media de 33,3 años. Se operaron 12 pies (en 11 pacientes) con pie plano adquirido del adulto secundario a insuficiencia del TTP (grado II) que fueron tratados (Figura 1) con osteotomía oblicua de desplazamiento medial de la tuberosidad posterior del calcáneo.A 9 de estos pies se le realizo transferencia del tendón FDL al TP y a 4 se le adiciono alargamiento de la columna externa (mediante osteotomía de Evans). Coincidentemente 3 de estos 4 fueron los que no llevaron tiempo medial para realizar la transferencia del FDL. A solo 1 paciente se le realizo los 3 tiempos quirúrgico (osteotomía medializante + Evans + transferencia del FDL). No se realizaron alargamientos del tendón de Aquiles. (Tabla 1) ConclusiónConcluimos que la adición de una osteotomía de desplazamiento medial del calcáneo es un procedimiento relativamente simple y necesario en el tratamiento de la disfunción del tibial posterior grado II. En la serie actual, parece haber ofrecido ventajas mecánicas y ha dado como resultado una mejora general de 120 PIES OSTEOTOMIA MEDIALIZANTE DE CALCANEO EVANS TRANSFERENCIA

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Section: Introductionunclassified

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Placa escalonada de calcáneo en insuficiencias del tibial posterior grado II. Serie de casos. Resultados radiológicos

Sini¹,

Navello²,

Mazzucchelli³

et al. 2017

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“…The condition of the PTT will dictate the type of procedure to perform (ie, tenosynovectomy, repair, tendon transfer), but in our experience soft tissue surgery alone can be insufficient. In order to protect the PTT from excessive stresses, we often combine PTT surgery in many cases with a medializing calcaneal osteotomy to correct heel valgus even though it is not as severe as in the other stages [3,19]. Heel valgus determines overload along the medial side of the foot, which could consequently lead to failure of the newly repaired PTT.…”

Section: Stage Imentioning

confidence: 99%

Approach and treatment of the adult acquired flatfoot deformity

Vulcano

Deland

Ellis

2013

Curr Rev Musculoskelet Med

103

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Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.

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Effects of surgical correction for the treatment of adult acquired flatfoot deformity: A computational investigation

Iaquinto

Wayne

2011

Journal Orthopaedic Research

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Computational models of the foot/ankle complex were developed to predict the biomechanical consequences of surgical procedures that correct for Stage II adult acquired flatfoot deformity. Cadaveric leg and foot bony anatomy was captured by CT imaging in neutral flexion and imported to the modeling software. Ligaments were approximated as tension only springs attached at insertion sites. Muscle contraction of the gastrocnemius/soleus complex was simulated through force vectors and desired external loads applied to the model. Ligament stiffnesses were modified to reflect Stage II flatfoot damage, followed by integration of corrective osteotomies—medializing calcaneal osteotomy (MCO) and Evans and calcaneocuboid distraction arthrodesis (CCDA)—to treat flatfoot. Joint angles, tissue strains, calcaneocuboid contact force, and plantar loads were analyzed. The flatfoot simulation demonstrated clinical signs of disease evidenced by degradation of joint alignment. Repair states corrected these joint misalignments with MCO having greatest impact in the hindfoot, and Evans/CCDA having greatest effect in the mid- and forefoot. The lateral procedures unevenly strained plantar structures, while offloading the medial forefoot, and increased loading on the lateral forefoot, which was amplified by combining with MCO. The Evans procedure raised calcaneocuboid joint contact force to twice intact levels. Computational results are in agreement with clinical and experimental findings. The model demonstrated potential precursors to such complications as lateral tightness and arthritic development and may thus be useful as a predictor of surgical outcomes. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1047–1054, 2011

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

Abstract: The surgical correction of stage II posterior tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular yielded excellent results with minimal complications and a high patient satisfaction rate.

Cited by 271 publications

References 37 publications

Placa escalonada de calcáneo en insuficiencias del tibial posterior grado II. Serie de casos. Resultados radiológicos

Placa escalonada de calcáneo en insuficiencias del tibial posterior grado II. Serie de casos. Resultados radiológicos

Approach and treatment of the adult acquired flatfoot deformity

Effects of surgical correction for the treatment of adult acquired flatfoot deformity: A computational investigation

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