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Medial post to promote hindfoot inversion
71%
882/1251
Medial post to promote hindfoot eversion
13%
161/1251
Lateral post to promote hindfoot inversion
10%
120/1251
Lateral post to promote forefoot varus
2%
31/1251
Lateral post to promote forefoot adduction
3%
41/1251
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Stage II posterior tibial tendon insufficiency (PTTI) can effectively be treated with orthotics if the patient has had improvement with physical therapy. This orthotic should consist of a medial post and arch support to promote hindfoot inversion. PTTI is the most common cause of adult-acquired flatfoot deformity. Stage II disease is characterized by the collapse of the longitudinal arch, flexible hindfoot, and the inability to perform a single-leg heel raise. Initial treatment of Stage II disease consists of nonoperative measures, including an ankle-foot orthosis and physical therapy (PT). If good results are achieved with PT, custom-molded orthotics are recommended. Such orthotics should consist of a medial post and arch support to promote hindfoot inversion. Stein et. al. review adult posterior tibial tendon dysfunction. They report that joint-sparing surgeries, such as corrective osteotomies and tendon transfers should be performed when nonoperative management has failed. They conclude that familiarity with the pertinent pathophysiology and treatment options is paramount to successful treatment. Deland et. al. review adult-acquired flatfoot deformity. They report that foot orthoses with a medial post and arch support are less cumbersome than a brace and provide good support and outcomes for lesser deformities. They conclude approximately 90% satisfaction can be achieved with nonoperative measures in patients with Stage II deformities. Tankson et. al. review the cotton osteotomy indications and treatment. They report that in Stage II disease the hindfoot drifts into valgus as compensatory varus develops in the forefoot. They conclude that lateral column instability can alter the forefoot and this should be evaluated for in PTTI. Incorrect Answers: Answer 2: A medial post is used, but this serves to create hindfoot inversion. Answer 3: A medial post should be used to create hindfoot inversion. Answers 4-5: A medial post, rather than a lateral post, should be built into the orthotics for patients with PTTI.
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