Abstract
Introduction
Grade II chronic tibialis posterior tendon dysfunction (PTTD) poses a reconstructive challenge to the orthopaedic surgeon. Aim of this retrospective study is to report the clinical and radiographical results of a case series of 63 patients (102 ft) affected by grade II PTTD who underwent tailored surgical treatment at 10-year mean follow-up.
Materials and methods
Sixty-three patients (102 ft) were available for clinical and radiological evaluation and were retrospectively reviewed at a mean follow-up of 125.1 ± 14.9 months. Tibialis posterior (PTT) treatment was based on the pathological anatomy of the degenerated tendon. PTT repair was performed in 53 cases. Flexor digitorum longus transfer was performed in the remaining 49. Associated procedures were represented by medial displacement calcaneal osteotomy (MDCO) and lateral column lengthening (LCL) depending on the main clinical feature of the foot (hindfoot valgus and forefoot abduction, respectively). Patients’ evaluation included AOFAS score and radiographic examination with measure of lateral talus-first metatarsal angle (LTFMA) and talo-navicular coverage angle (TNCA).
Results we observed four failures
AOFAS hindfoot score was 89 ± 10 points at final follow-up. Eighty-six per cent of the patients declared to be satisfied or satisfied with minor reservations. An overall statistical significant decrease was observed in both LTFMA and TNCA values. A better TNCA correction was observed in case of associated LCL with respect to MDCO.
Discussion
Tailored PTT treatment associated with MDCO or LCL seems provide long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction.
Similar content being viewed by others
References
Kulowsi J (1936) Tendovaginitis (tenosynovitis). J Mo State Med Assn 33:135–137
Kitaoka HB, Ahn TK, Luo ZP, An KN (1997) Stability of the arch of the foot. Foot Ankle Int 18:644–648
Frey C, Shereff M, Greenidge N (1990) Vascularity of the posterior tibial tendon. J Bone Joint Surg Am 72:884–888
Kohls-Gatzoulis J, Woods B, Angel JC, Singh D (2009) The prevalence of symptomatic posterior tibialis tendon dysfunction in women over the age of 40 in England. Foot Ankle Surg 15:75–81. doi:10.1016/j.fas.2008.08.003
Gluck GS, Heckman DS, Parekh SG (2010) Tendon disorders of the foot and ankle, part 3: the posterior tibial tendon. Am J Sports Med 38:2133–2144. doi:10.1177/0363546509359492
Bluman EM, Title CI, Myerson MS (2007) Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 12:233–249. doi:10.1016/j.fcl.2007.03.003
Johnson KA, Strom DE (1989) Tibialis posterior tendon dysfunction. Clin Orthop 239:196–206
Myerson MS (1997) Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. Instr Course Lect 46:393–405
Chadwick C, Whitehouse SL, Saxby TS (2015) Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction. Bone Joint J 97B:346–352. doi:10.1302/0301-620X.97B3.34386
Deland JT (2008) Adult-acquired flatfoot deformity. J Am Acad Orthop Surg 16:399–406
Giza E, Cush G, Schon LC (2007) The flexible flatfoot in the adult. Foot Ankle Clin 12:251–271. doi:10.1016/j.fcl.2007.03.008
Kou JX, Balasubramaniam M, Kippe M, Fortin PT (2012) Functional results of posterior tibial tendon reconstruction, calcaneal osteotomy, and gastrocnemius recession. Foot Ankle Int 33:602–611. doi:10.3113/FAI.2012.0001
Zaw H, Calder JDF (2010) Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review. Knee Surg Sports Traumatol Arthrosc 18:135–142. doi:10.1007/s00167-009-1015-6
Wacker JT, Hennessy MS, Saxby TS (2002) Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of tibialis posterior. Three- to five-year results. J Bone Joint Surg Br 84:54–58
Rosenberg ZS, Cheung Y, Jahss MH et al (1988) Rupture of posterior tibial tendon: CT and MR imaging with surgical correlation. Radiology 169:229–235. doi:10.1148/radiology.169.1.3420263
Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353
Guyton GP, Jeng C, Krieger LE, Mann RA (2001) Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for posterior tibial tendon dysfunction: a middle-term clinical follow-up. Foot Ankle Int 22:627–632
Iossi M, Johnson JE, McCormick JJ, Klein SE (2013) Short-term radiographic analysis of operative correction of adult acquired flatfoot deformity. Foot Ankle Int 34:781–791. doi:10.1177/1071100713475432
Mann RA, Thompson FM (1985) Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg Am 67:556–561
Shereff M (1997) Treatment of ruptured posterior tibial tendon with direct repair and FDL tenodesis. Foot Ankle Clin 2:281–296
Cracchiolo A (1997) Evaluation of spring ligament pathology in patients with posterior tibial tendon rupture, tendon transfer and ligament repair. Foot Ankle Clin 2:297–307
Hiller L, Pinney SJ (2003) Surgical treatment of acquired flatfoot deformity: what is the state of practice among academic foot and ankle surgeons in 2002? Foot Ankle Int 24:701–705
Knupp M, Hintermann B (2007) The Cobb procedure for treatment of acquired flatfoot deformity associated with stage II insufficiency of the posterior tibial tendon. Foot Ankle Int 28:416–421. doi:10.3113/FAI.2007.0416
Parsons S, Naim S, Richards PJ, McBride D (2010) Correction and prevention of deformity in type II tibialis posterior dysfunction. Clin Orthop 468:1025–1032. doi:10.1007/s11999-009-1122-1
Silva MGAN, Tan SHS, Chong HC et al (2015) Results of operative correction of grade IIB tibialis posterior tendon dysfunction. Foot Ankle Int 36:165–171. doi:10.1177/1071100714556758
Haeseker GA, Mureau MA, Faber FWM (2010) Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis. J Foot Ankle Surg 49:380–384. doi:10.1053/j.jfas.2010.04.023
Marks RM, Long JT, Ness ME et al (2009) Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy. Gait Posture 29:17–22. doi:10.1016/j.gaitpost.2008.05.012
Conti S, Michelson J, Jahss M (1992) Clinical significance of magnetic resonance imaging in preoperative planning for reconstruction of posterior tibial tendon ruptures. Foot Ankle 13:208–214
Baxter JR, Demetracopoulos CA, Prado MP et al (2015) Lateral column lengthening corrects hindfoot valgus in a cadaveric flatfoot model. Foot Ankle Int 36:705–709. doi:10.1177/1071100715571439
Chang TJ, Lee J (2007) Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction. Clin Podiatr Med Surg 24:687–697. doi:10.1016/j.cpm.2007.07.008
Zhu Y, Xu X-Y (2015) Treatment of stage II adult acquired flatfoot deformity with subtalar arthroereises. Foot Ankle Spec 8:194–202. doi:10.1177/1938640014548320
Grier KM, Walling AK (2010) The use of tricortical autograft versus allograft in lateral column lengthening for adult acquired flatfoot deformity: an analysis of union rates and complications. Foot Ankle Int 31:760–769. doi:10.3113/FAI.2010.0760
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Ruffilli, A., Traina, F., Giannini, S. et al. Surgical treatment of stage II posterior tibialis tendon dysfunction: ten-year clinical and radiographic results. Eur J Orthop Surg Traumatol 28, 139–145 (2018). https://doi.org/10.1007/s00590-017-2011-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-017-2011-z