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Tendon transfer, lateral column lengthening, and heel cord lengthening
40%
56/140
Triple arthrodesis and heel cord lengthening
1%
1/140
Tendon transfer, lateral column lengthening, medial column arthrodesis, and heel cord lengthening
23%
32/140
Tendon transfer, spring ligament repair, and heel cord lengthening
20%
28/140
Tendon repair, medial displacement calcaneal osteotomy, and heel cord lengthening
16%
22/140
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The patient has an atypical adult flatfoot deformity. The radiographs reveal forefoot abduction, mild loss of calcaneal pitch, and marked plantar flexion sag through the naviculocuneiform joint. The inability to perform a single limb heel rise indicates that the posterior tibial tendon is nonfunctional; however, the deformity remains flexible. In this patient, surgical treatment should include a tendon transfer, lateral column lengthening, medial column arthrodesis, and heel cord lengthening. Because a substantial portion of the deformity stems from the naviculocuneiform joint in this instance, tendon transfer and lateral column lengthening alone provide insufficient deformity correction. Triple arthrodesis and heel cord lengthening is best reserved for fixed flatfoot deformities. Soft-tissue procedures alone are associated with a high failure rate, as are attempted tendon repairs.
1.4
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