Treatment of adult acquired pes plano abductovalgus (flatfoot deformity): procedures that preserve complex hindfoot motion
Section snippets
Soft tissue procedures
Tendon rerouting procedures are designed to alter the force vectors. Flexor digitorum longus (FDL) transfer to the posterior tibial tendon (PTT) is the most commonly performed tendon rerouting procedure.2, 3, 4, 5, 6 Other techniques include spring ligament reconstruction7, 8 and Young suspension.9 The Young suspension reroutes the tibialis anterior tendon along an osseous groove at the plantar-medial surface of the medial cuneiform and navicular, but leaves its insertion intact. To do this,
First tarsometatarsal arthrodesis
In cases of an acute “sag” of the tarsometatarsal joint, arthrodesis can be a helpful adjunct. First tarsometatarsal (TMT) osteotomy and fusion is performed through a dorsal incision centered over the first TMT joint.11, 12 Apply a tourniquet to the thigh. Develop the interval between the extensor hallucis longus and brevis. Making sure to maintain the thin periosteal tissue and joint capsule for later closure over the osteotomy, raise the medial and lateral subperiosteal flaps. Marking these
Calcaneal osteotomy
As stated previously, it is unreasonable to think that one single procedure could be capable of correcting all forms of acquired adult flatfoot. Obviously, multiple surgical procedures exist15 and are more or less suitable in any given case. The surgeon must always weigh the benefits and drawbacks accordingly, then select the most appropriate method of treatment. In complex cases of flatfoot, one or more of the above procedures can be used in combination with a calcaneus tuberosity osteotomy,16
Postoperative management
Cover all wounds with xeroform, bacitracin, and sterile dry gauze dressings held with sterile under-cast padding. For the first 2 weeks after the operation, use a three-sided plaster splint or SLC with the anterior strip removed. After 2 weeks, change from this arrangement to a regular SLC for 4 to 6 more weeks. The patient must remain nonweight-bearing during this period. When the short cast is removed, radiographs are necessary to check healing. Then the patient is placed in a below knee
Summary
Treating flatfoot deformity without sacrificing complex hindfoot motion is a challenge to even the most skillful surgeon. During the preoperative period, it is important to discuss the postoperative course with the patient so that they know what to reasonably expect from their treatment. For example, swelling can persist for a year or more, and it can take 18 to 24 months for the patient to fully realize the benefits of the corrective surgery. Clear communication between the surgeon and the
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Cited by (7)
Analysis of the main passive soft tissues associated with adult acquired flatfoot deformity development: A computational modeling approach
2019, Journal of BiomechanicsCitation Excerpt :Adult Acquired Flatfoot Deformity (AAFD) has become a clinical research issue in recent years, motivated by the increasing prevalence of this pathology and the huge variability of currently available treatment alternatives (Lee et al., 2005; Shibuya et al., 2010). Depending on the stage of the pathology, doctors must decide between tendon reinforcement techniques, corrective osteotomies of the hindfoot valgus moment or selective arthrodesis in the middle and hindfoot joints (Fowble & Sands, 2004; Guha & Perera, 2012; Toullec, 2015). Therefore, currently there is no generally accepted consensus on how to act on patients in the intermediate stages (flexible arch deformity) (Bluman et al., 2007; Vulcano et al., 2013).
Biomechanical stress analysis of the main soft tissues associated with the development of adult acquired flatfoot deformity
2019, Clinical BiomechanicsCitation Excerpt :Adult acquired flatfoot deformity (AAFD) is a pathology that causes a progressive flattening of the foot arch, traditionally related to the weakening of the Tibialis Posterior Tendon (TPT) (Smyth et al., 2017). Many treatment options are focused on reinforcing this tissue, but sometimes the foot deformation appears again over time, necessitating the use of more aggressive and restrictive options such as selective arthrodesis in the middle and hindfoot joints or corrective osteotomies of the hindfoot valgus moment (Fowble and Sands, 2004; Guha and Perera, 2012; Lladó et al., 2015; Toullec, 2015; Bluman et al., 2007; Vulcano et al., 2013; Valladar et al., 2015). This scenario often appears in the intermediate stages of the disease and currently there is no accepted consensus on the appropriate treatment (Fowble and Sands, 2004).
Arthrodesis for the treatment of acquired flatfoot deformity
2014, Fuss und SprunggelenkEffect of the calcaneal medializing osteotomy on soft tissues supporting the plantar arch: A computational study
2019, Revista Espanola de Cirugia Ortopedica y TraumatologiaAnalysis of the main soft tissue stress associated with flexible flatfoot deformity: a finite element study
2021, Biomechanics and Modeling in Mechanobiology