J Korean Foot Ankle Soc.  2014 Sep;18(3):93-99. 10.14193/jkfas.2014.18.3.93.

Operative Treatment of Acquired Adult Flatfoot

• Ahn CY
• Ahn JH
• Kim MS

• KMID: 2333471
• DOI: http://doi.org/10.14193/jkfas.2014.18.3.93

Abstract

Acquired adult flatfoot deformity is characterized by flattening of the medial longitudinal arch and dysfunction of the posteromedial soft tissues, including the posterior tibial tendon. When the non-operative treatment fails to result in improvement of symptoms, surgery should be considered. Operative techniques include flexor digitorum longus tendon transfer, calcaneal medial slide osteotomy, lateral column lengthening, and arthrodesis of the hindfoot. The principle of correcting the deformity while avoiding overcorrection and excessive stiffness is important in achievement of good outcomes in these patients.

Keyword

Acquired adult flatfoot deformity; Posterior tibial tendon; Flexor digitorum longus tendon transfer; Calcaneal medial slide osteotomy; Lateral column lengthening

MeSH Terms

Adult*
Arthrodesis
Congenital Abnormalities
Flatfoot*
Humans
Osteotomy
Tendon Transfer
Tendons

Figure

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  Figure 1. (A) The photograph of left foot showed swelling (black arrow) around the tibialis posterior tendon. (B) The ultrasonograph of left foot demonstrated mild thickening of the tendon with surrounding effusion (white arrow). (C) Under the diagnosis of stage 1 acquired adult flatfoot deformity or tibialis posterior tenosynovitis, a tenosynovectomy was performed. TP: tibialis posterior tendon, Tal: talus.

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  Figure 2. (A) The photograph of both heel showed a valgus deformity and ‘too many toes’ sign in the left side. (B) The standing anteroposterior radiograph of left foot demonstrated mild abduction in the midfoot. The talonavicular uncoverage was measured to be 25%. (C) Under the diagnosis of stage 2a acquired adult flatfoot deformity, a flexor digitorum longus tendon transfer was performed. (D) The tendon transfer was combined with a calcaneal medial slide osteotomy.

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  Figure 3. The photograph (A) and standing lateral radiograph (B) of left foot showed a severe flatfoot deformity, which was diagnosed as stage 2b acquired adult flatfoot deformity. (C) A calcaneal medial slide osteotomy and a lateral column lengthening were performed at the same time to correct the severe deformity. (D) Postoperative lateral radiograph showed the well-fixed double osteotomies.

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  Figure 4. (A) Stage 3 acquired adult flatfoot deformity was seen at preoperative standing lateral radiograph of 47-year-old male patient. (B) Triple arthrodesis was performed for the rigid flatfoot deformity.

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  Figure 5. Preoperative standing anteroposterior (A) and lateral (B) radiographs of a 62-year-old female patient showed a valgus deformity of ankle joint with a severe flatfoot deformity. Postoperative anteroposterior (C) and lateral (D) radiographs showed the triple arthrodesis and extended medial column fusion combined with a deltoid ligament reconstruction, which were performed under the diagnosis of stage 4 acquired adult flatfoot deformity.

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  Figure 6. This photograph demonstrates the technique of gastrocnemius recession.

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