Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot - Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults

Background: The successful correction of flatfoot in children through lengt hening of the lateral column, osteotomy of the medial cuneiform, and advanc ement of the posterior tibial tendon led to the introduction of similar pro cedures to treat acquired pes planovalgus secondary to attrition or rupture of the posterior tibial tendon in adults. However, to our knowledge, no st udy has been published documenting whether these procedures are effective t reatment for acquired flatfoot in adults. Methods: The functional and radiographic results of complex reconstruction of a painful, flexible flatfoot associated with attrition or rupture of the posterior tibial tendon were evaluated in thirty-six patients (forty-one f eet) with use of a detailed questionnaire, a comprehensive physical examina tion, and a review of the radiographs and the medical record. Results: At a mean of thirty-four months (range, twenty-four to fifty month s) postoperatively; thirty-six feet (88 percent) were less painful compared with the preoperative status or mere pain-free and five of the six paramet ers that had been used to assess correction of the deformity radiographical ly had improved significantly (p < 0.0001), Eight feet (20 percent) had a n onunion at the calcaneocuboid joint, and thirteen feet (32 percent) had ane sthesia or paresthesia of the sural nerve. Twenty-nine feet (71 percent) ha d had additional operations, including removal of hardware from twenty feet ; bone-grafting to treat a nonunion at the site of the calcaneocuboid arthr odesis and revision of the internal fixation in four feet; a medial displac ement calcaneal osteotomy because of recurrent valgus angulation of the hin dfoot in two feet; and a Lapidus procedure because of a hypermobile tarsome tatarsal joint with hallux valgus, a triple arthrodesis because of a nonuni on at the site of the calcaneocuboid arthrodesis associated,vith loss of co rrection, and a dorsiflexion-abduction wedge osteotomy through the site of the calcaneocuboid arthrodesis (which had healed) for alignment of an overc orrected foot in one foot each. The outcomes of the procedures in thirty-fi ve feet (85 percent) were rated by the patients as satisfactory, and thirty -three (92 percent) of the thirty-sis patients (thirty-eight [93 percent] o f the forty-one feet) stated that they would have the procedure again if th e circumstances were similar. Conclusions: Despite the high prevalence of postoperative complications, mo st of our patients were satisfied with the result of the procedure after th e short duration of follow-up, We believe that the relief of pain and the r estoration of function achieved through effective correction of the severe pes planovalgus deformity account for the satisfactory outcomes in our pati ents.