Posterior Tibial Tendon Insufficiency (PTTI) Pathway Posted: 6/15/2020 ID: (C101502) Naval Medical Center Portsmouth

Acquired Pes Planovalgus in 47M

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OUTCOMES
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EVIDENCE
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CASE DESCRIPTION
AGE 47 / Male
CC Left foot pain
HPI A 47 year-old male presents with chronic left foot pain and a flatfoot deformity. He attempted shoewear modifications, physical therapy, and custom orthotics (including medial posting with medial arch support) for an extended period of time. Despite this symptoms remain severe.
PMH Unremarkable
PE On physical exam on the left foot there is a pes planovalgus with "too many toes" sign. He is unable to perform a single leg heel rise on the affected side. The deformity is passively correctable. He otherwise has good strength. His neurovascular exam is normal.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101502/7a379228-d879-4884-b72b-e4c8cd4049bd_picture1.jpg https://upload.orthobullets.com/cases/101502/356dd496-d0dc-4749-a844-e3ab3ebfb230_picture2.jpg https://upload.orthobullets.com/cases/101502/d519f465-49a5-428e-b53c-f556a50de829_axial_mri.jpg https://upload.orthobullets.com/cases/101502/25fc55bd-8a17-43d1-afde-a01a5ef25e93_coronal_mri.jpg
POLLS
OB Community
1) Would you obtain imaging in addition to the plain film weight-bearing radiographs to guide management?
Other
2) Would you classify this pathology to guide management?
Other
3) Given that the patient has exhausted at least 3 months of conservative management, how would you manage the patient at this time?
Other
4) If you choose Operative management, what surgery would you perform?
Other
5) If you choose Operative management with a Bone Reconstruction, which would you perform?
Other
6) If you choose Operative management with a Soft tissue Reconstruction, which would you perform?
Other
7) If you choose Operative management, would you include a Tendon Achilles lengthening (TAL)?
Other
8) If you choose Operative management with an Arthrodesis, which would you perform?
Other
9) If you choose Operative management and achieved the construct shown below, what would you postoperative protocol be?
Other
10) If you choose Operative management and achieved the construct shown below, how long would you maintain the patient in an orthosis postoperatively?
Other
CASE OUTCOMES
PROCEDURE 1: Mediallizing calcaneal osteotomy, 1st metatarsal dorsal opening wedge osteotomy, temporary pinning of reduced talonavicular joint, spring ligament repair, posterior tibialis tendon advancement (in lieu of FDL transfer)
Intra-procedure P1
https://upload.orthobullets.com/cases/101502/328490df-d4c5-4ccc-a4ba-7d1f0fe95d66_intraop_2.jpg https://upload.orthobullets.com/cases/101502/e4355329-b143-441f-ba06-76f1af5a9cfd_intraop_2a.jpg https://upload.orthobullets.com/cases/101502/60d2b69d-4253-4cb0-b188-cd962ef44c53_intraop_1.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/101502/585a4a88-b84c-4112-abd6-1d85be047eeb_immed_postop_1.jpg https://upload.orthobullets.com/cases/101502/9cae889c-bdcf-4f7d-a3e4-1ef6e065d467_immed_postop_2.jpg https://upload.orthobullets.com/cases/101502/af676345-41f7-42b1-b7a0-561bde641121_postop_late.jpg https://upload.orthobullets.com/cases/101502/a6856633-eaab-462f-b5e8-17c5777f0b3b_postop_late_2.jpg
VIDEOS & PODCASTS (3)
All Videos (3) Podcasts (0)
California Orthopaedic Association Annual Meeting - 2017
Posterior Tibial Tendonopathy – David Sitler, M.D.(COA 2017, 7.4)
  • Foot & Ankle
  • - Posterior Tibial Tendon Insufficiency (PTTI)
A
4/12/2018
3332 views
4.7
(6)
2017 Current Solutions in Foot & Ankle Surgery
Rigid Adult Flatfoot: Samuel Flemister, MD (CSFA #18, 2017)
  • Foot & Ankle
  • - Posterior Tibial Tendon Insufficiency (PTTI)
B
5/15/2017
2893 views
4.3
(3)
2017 Current Solutions in Foot & Ankle Surgery
Flexible Adult Flatfoot: Arthur Manoli, MD (CSFA #17, 2017)
  • Foot & Ankle
  • - Posterior Tibial Tendon Insufficiency (PTTI)
B
5/15/2017
1900 views
4.3
(6)
EVIDENCE (22)
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