Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 8 , ISSUE 2 ( April-June, 2021 ) > List of Articles

MINI-SYMPOSIUM: FLATFOOT IN ADULTS

Controversies in the Management of Stage II Flatfoot

Pisit Boonma, Chamnanni Rungprai

Keywords : Acquired adult flatfoot, Arthrodesis, Arthroereisis, Cotton osteotomy, Flexible flatfoot, Lateral column lengthening, Medial calcaneal sliding osteotomy, Posterior tibialis tendon dysfunction, Spring ligament reconstruction

Citation Information : Boonma P, Rungprai C. Controversies in the Management of Stage II Flatfoot. J Foot Ankle Surg Asia-Pacific 2021; 8 (2):55-59.

DOI: 10.5005/jp-journals-10040-1153

License: CC BY-NC 4.0

Published Online: 00-06-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Stage II flatfoot patients will complain about pain on the medial side of midfoot and hindfoot due to tendinitis and tendinosis of medial foot structure, such as, posterior tibialis tendon (PTT) and spring ligament and some will complaint the lateral midfoot and hindfoot pain due to impingement of lateral structure; the peroneus, fibula, and lateral process of the talus. There are many etiologies to explain flatfoot deformity pathology. Previously, posterior tibialis tendon dysfunction (PTTD) was known as the primary problem. Nowadays, many works of literature explain the cause of flat feet that not only the dysfunctional PTT. The reports of isolated spring ligament torn and the shortening of the calcaneus also thought to be the causes. Due to many subtypes and disease pathologies, the management in stage II flat feet are diverse. This topic will discuss the main approach of type II flatfoot and the controversies topics, such as, the amount of medial calcaneal sliding osteotomy, how to correct forefoot abduction, forefoot varus, arthroereisis, or arthrodesis.


PDF Share
  1. Adult acquired flatfoot deformity. Foot Ankle Int 2011;32(1):95–111. DOI: 10.3113/FAI.2011.0095.
  2. Adult flatfoot. Orthop Traumatol Surg Res 2015;101(1):S11–S17. DOI: 10.1016/j.otsr.2014.07.030.
  3. Adult-acquired flatfoot deformity. Foot Ankle Orthop 2019;4(1):247301141882084 10.1177/2473011418820847.
  4. Biomechanics and clinical analysis of the adult acquired flatfoot. Clin Podiatr Med Surg 2007;24(4):617–644. DOI: 10.1016/j.cpm.2007.07.003.
  5. Biomechanics and pathophysiology of flat foot. Foot Ankle Clin 2003;8(3):419–430. DOI: 10.1016/S1083-7515(03)00084-6.
  6. Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: are they one and the same? A systematic review. PLoS ONE 2017;12(12):1–17. DOI: 10.1371/journal.pone.0187201.
  7. Approach and treatment of the adult acquired flatfoot deformity. Curr Rev Musculoskelet Med 2013;6(4):294–303. DOI: 10.1007/s12178-013-9173-z.
  8. Acquired adult flat foot due to isolated plantar calcaneonavicular (spring) ligament insufficiency with a normal posterior tibialis tendon. Foot Ankle Surg 2008;14(2):89–95. DOI: 10.1016/j.fas.2007.11.005.
  9. Neutral heel lateral push test: The first clinical examination of spring ligament integrity. Foot 2015;25(2):69–74. DOI: 10.1016/j.foot.2015.02.003.
  10. Adult-acquired flatfoot deformity. Eur J Orthop Surg Traumatol 2017;27(4):433–439. DOI: 10.1007/s00590-017-1945-5.
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140804/pdf/jpts-28-3078.pdf. Accessed September 16, 2018.
  12. Getting the right balance: insole design alters the static balance of people with diabetes and neuropathy. J Foot Ankle Res 2016;9(1):40. DOI: 10.1186/s13047-016-0172-3.
  13. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg 2005;44(2):78–113. DOI: 10.1053/j.jfas.2004.12.001.
  14. Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal Radiol 2010;39(11):1103–1108. DOI: 10.1007/s00256-009-0857-9.
  15. Radiologic analysis of hindfoot alignment: comparison of Méary, long axial, and hindfoot alignment views. Orthop Traumatol Surg Res 2017;103(8):1211–1216. DOI: 10.1016/j.otsr.2017.08.014.
  16. The flexible flatfoot in the adult. Foot Ankle Clin 2007;12(2):251–271. DOI: 10.1016/j.fcl.2007.03.008.
  17. The hind- and midfoot alignment computed after a medializing calcaneal osteotomy using a 3D weightbearing CT. Int J Comput Assist Radiol Surg 2019;14(8):1439–1447. DOI: 10.1007/s11548-019-01949-7.
  18. Forefoot supination and medial column instability in the setting of AAFD: the role of the medial column. Tech Foot Ankle Surg 2019;18(3):132–140. DOI: 10.1097/BTF.0000000000000224.
  19. Current concept review: acquired adult flatfoot deformity. Foot Ankle Int 2006;27(1):66–75. DOI: 10.1177/107110070602700113.
  20. Medial displacement calcaneal osteotomy in treatment of stage II posterior tibial tendon deficiency. Egypt Orthop J 2017(July):38–44. DOI: 10.4103/eoj.eoj.
  21. Calcaneal osteotomies. Foot Ankle Clin 2005;10(3):523–540. DOI: 10.1016/j.fcl.2005.04.005.
  22. Comparative results of percutaneous calcaneal osteotomy in correction of hindfoot deformities. Foot Ankle Int 2019;40(3):276–281. DOI: 10.1177/1071100718809449.
  23. Calcaneus osteotomy. Curr Rev Musculoskelet Med 2014;7(4):271–276. DOI: 10.1007/s12178-014-9237-8.
  24. Neurovascular and clinical outcomes of the percutaneous endoscopically assisted calcaneal osteotomy (PECO) technique to correct hindfoot malalignment. Foot Ankle Int 2019;40(2):178–184. DOI: 10.1177/1071100718800983.
  25. A comparison of union rates and complications between single screw and double screw fixation of sliding calcaneal osteotomy. Foot Ankle Surg 2019;25(1):84–89. DOI: 10.1016/j.fas.2017.08.007.
  26. Calcaneal osteotomy safe zone to prevent neurological damage: fact or fiction? Foot Ankle Spec 2019;12(1):34–38. DOI: 10.1177/1938640018762556.
  27. Medial column procedures in the correction of adult acquired flatfoot deformity. Foot Ankle Clin 2012;17(2):283–298. DOI: 10.1016/j.fcl.2012.03.003.
  28. The biplanar effect of the medial cuneiform osteotomy. Foot Ankle Spec 2019;13(3):250–257. DOI: 10.1177/1938640019868061.
  29. A plantar closing wedge osteotomy of the medial cuneiform for residual forefoot supination in flatfoot reconstruction. Foot Ankle Int 2013;34(9):1221–1226. DOI: 10.1177/1071100713487726.
  30. The role of isolated gastrocnemius and combined achilles contractures in the flatfoot. Foot Ankle Clin 2007;12(2):363–379. DOI: 10.1016/j.fcl.2007.03.005.
  31. Three-dimensional displacement after a medializing calcaneal osteotomy in relation to the osteotomy angle and hindfoot alignment. Foot Ankle Surg 2018;26(1):78–84.
  32. Three-dimensional analysis of flatfoot deformity: cadaver study. Foot Ankle Int 1998;19(7):447–451. DOI: 10.1177/107110079801900705.
  33. Anatomic spring ligament and posterior tibial tendon reconstruction: new concept of double bundle ptt and a novel technique for spring ligament. Arch Bone Jt Surg 2017;5(3):201–205. DOI: 10.22038/abjs.2017.22968.1611.
  34. Biomechanical assessment of flexible flatfoot correction. J Bone Jt Surg 2014;96(6):e45. DOI: 10.2106/jbjs.l.00258.
  35. Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model. J Orthop Surg Res 2019;14(1):5–7. DOI: 10.1186/s13018-019-1154-5.
  36. Lateral column lengthening and how to achieve good correction. Tech Foot Ankle Surg 2014;13(1):23–28. DOI: 10.1097/BTF.0000000000000036.
  37. Adult-acquired flatfoot and posterior tibial tendon dysfunction. Orthopaedic Knowledge Update Foot and Ankle 2014;5:167–169.
  38. Operative treatment of the difficult stage 2 adult acquired flatfoot deformity. Foot Ankle Clin 2001;6(1):95–119. DOI: 10.1016/S1083-7515(03)00083-4.
  39. Severe flexible pes planovalgus deformity correction using trabecular metallic wedges. Foot Ankle Int 2019;40(4):402–407. DOI: 10.1177/1071100718816054.
  40. Medial cuneiform opening wedge osteotomy for correction of flexible flatfoot deformity: trabecular titanium vs. bone allograft wedges. Biomed Res Int 2019(1):1–7. DOI: 10.1155/2019/1472471.
  41. Postoperative medial cuneiform position correlation with patient-reported outcomes following cotton osteotomy for reconstruction of the stage II adult-acquired flatfoot deformity. Foot Ankle Int 2019;40(5):491–498. DOI: 10.1177/1071100718822839.
  42. Isolated medial column stabilization improves alignment in adult-acquired flatfoot. Clin Orthop Relat Res 2005;435(435):197–202. DOI: 10.1097/01.blo.0000157658.17056.46.
  43. The role of arthroereisis of the subtalar joint for flatfoot in children and adults. EFORT Open Rev 2017;2(11):438–446. DOI: 10.1302/2058-5241.2.170009.
  44. Symptomatic flexible flatfoot in adults: subtalar arthroereisis. Ther Clin Risk Manag 2015;11:1597–1602. DOI: 10.2147/TCRM.S90649.
  45. Is there a role for subtalar arthroereisis in the management of adult acquired flatfoot? Foot Ankle Clin 2012;17(2):271–281. DOI: 10.1016/j.fcl.2012.03.006.
  46. Acquired adult flat foot secondary to posterior tibial-tendon pathology. J Bone Jt Surg - Ser A 1986;68(1):95–102. DOI: 10.2106/00004623-198668010-00012.
  47. Acquired flatfoot deformity secondary to dysfunction of the posterior tibialis tendon. Acta Orthop Belg 2003;69(3):211–221.
  48. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. Instr Course Lect 1997;46:393–405.
  49. Arthrodesis techniques in the management of stage II and III acquired adult flatfoot deformity. Instr Course Lect 2006;55:531–542.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.