Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon

We analyzed our results of surgery for acquired flatfoot deformity after dy sfunction of the posterior tibial tendon. This included lengthening the pro ximal lateral column by calcaneal osteotomy and reconstructing the medial s oft tissue. Nineteen patients (9 women and 10 men; average age, 52.9 years [range, 24-72 years]) were treated for stage II and stage II-III insufficie ncy of the posterior tibial tendon. The medial soft tissue surgery included 18 reconstructions of the tendon, 11 transfers of the flexor digitorum lon gus tendon, 13 repairs of the deltoid ligament, and 3 repairs of the spring ligament. At follow-up (mean, 23.4 months), all patients had satisfactory restoration of their medial longitudinal arch, reduction of abduction in th e forefoot, and restored height in the arch. All patients were able to bear weight fully on the foot that underwent surgery, and all but one were sati sfied with the result achieved. The clinical result was rated as excellent in 6, good in 11, and fair in 2 cases. In all but one case, no loss of achi eved correction in the foot was found, In one case, the calcaneocuboid join t had to undergo arthrodesis after 5 months because of painful degenerative joint disease. In the pes planovalgus and ab-ductus deformities occurring in stage II disease, calcaneal osteotomy and reconstruction of the medial t endon and ligament seem to play a significant role in operative management. This was the case only when degenerative joint disease and significant sub luxation of the subtalar or talonavicular joint or both had not already occ urred. They seem to function by restoring more normal biomechanics, which a llows reconstructed or transferred tendon to function successfully.