Review Question - QID 159

This patient has stage II posterior tibial tendon insufficiency, a flexible pes planovalgus deformity and inability to perform a single limb heel rise. Operative treatment includes gastrocnemius lengthening to improve dorsiflexion, FDL transfer to the navicular to reproduce posterior tibial tendon function, lateral column lengthening, and medializing calcaneal osteotomy to correct bony deformity. Moseir-LaClair et al report 5 year follow-up of 26 patients with Stage II treated with this constellation of procedures. They reported a mean postoperative ankle-hindfoot score of 90 and no nonunions. Four patients (14%) displayed radiographic signs of calcaneocuboid arthritis at follow-up with only one that was symptomatic and required calcaneocuboid joint fusion. Arthrodesis is not indicated for flexible deformities. Myerson et al reviewed the radiographic follow-up of 18 patients who underwent FDL transfer and medializing calcaneal osteotomy for flexible pes planovalgus. Radiographs demonstrated reduction of the magnitude of deformity, and the authors hypothesized that the bony reconstruction optimizes the dynamic forces of the FDL.