Flatfoot deformity, defined as loss of medial longitudinal arch, sometimes involves symptoms such as medial arch pain or Achilles tendon tightening, etc. Whether the etiology of deformity is congenital or acquired, i.e., posterior tibial tendon dysfunction, symptoms are largely resolved with conservative treatment including medication, orthoses, and activity modification. Surgery should be considered in cases of failure of conservative treatment and clinicians can select an appropriate technique among many surgical options including calcaneal osteotomy or flexor digitorum longus tendon transfer. Principles of corrective surgery include the recovery of alignment and the preservation of joint motion.
Achilles Tendon ; Congenital Abnormalities* ; Flatfoot* ; Joints ; Orthotic Devices ; Osteotomy ; Posterior Tibial Tendon Dysfunction ; Tendon Transfer

PURPOSE: This study was performed to investigate the dynamic effect of medial displacement calcaneal osteotomy (MCO) on the calcaneal inversion. MATERIALS AND METHODS: 10 fresh-frozen, intact cadaver foot-ankle specimens were tested, using a custom loading apparatus at an orientation consistent with the early heel rise portion (40%) of the gait cycle. Calcaneal inversion was measured with identical ground reac-tion force and tendon force, before and after MCO. RESULTS: Calcaneal inversion was 2.1+/-2.4degrees in the pre-osteotomy condition and 3.7+/-3.1degrees after MCO. Calcaneal plantar flexion was 7.1+/-0.7degrees in the pre-osteotomy condition and 8.8+/-1.8degrees after MCO. Increases of calcaneal inversion and flexion were significant (intact vs. MCO), (p< 0.05). CONCLUSION: The inversion capability of the Achilles tendon was enhanced by lengthening its moment arm when its insertion was displaced medially following MCO. MCO, therefore, could compensate for the weaker inverting power of the transferred toe flexor, when treating stage II posterior tibial tendon insufficiency.
Achilles Tendon ; Arm ; Cadaver ; Calcaneus ; Gait ; Heel ; Osteotomy* ; Posterior Tibial Tendon Dysfunction ; Tendons ; Toes

Flatfoot deformity in adults is a type of postural deformity of the foot in which the arch collapses. This condition includes a wide spectrum of clinical situations, ranging from asymptomatic to progressive and disabling pathology. The common causes of adult-acquired flatfoot deformity are sustained flexible flatfoot from childhood, posterior tibial tendon insufficiency, tarsal coalition, generalized inflammatory diseases, neuropathic arthropathy, and posttraumatic deformities. The treatment of adult acquired flatfoot deformity should be individualized in each case, depending on the causes, symptoms, severity of deformity, and flexibility of the deformity. Therefore, it is mandatory for physicians to be acquainted with the basic pathomechanics of flatfoot deformity as well as the diagnostic procedures and treatments for each condition. The treatment usually begins with conservative methods and variable surgical procedures could be selectively performed. This article reviews the basic pathoanatomy, the diagnostic procedures for various causes and the treatment of flatfoot deformity in adult.
Adult* ; Congenital Abnormalities ; Diagnosis ; Flatfoot* ; Foot ; Humans ; Pathology ; Pliability ; Posterior Tibial Tendon Dysfunction

Flatfoot is defined as loss of medial arch with hindfoot valgus, but normal condition is obscure due to wide individual variance. Loss or decreasing of medial longitudinal arch with radiographic image is clinically diagnosed as flatfoot. Flatfoot without symptoms is not an indication for treatment. The etiologies of flatfoot are congenital cause, hypermobility, tarsal coalition, neuromuscular disease, posttraumatic deformity, Charcot arthropathy, and posterior tibial tendon dysfuction. The flatfoot is classified as congenital and acquired, flexible, and rigid. The diagnosis is made by physical examination and radiographic findings. In particular, the posterior tibial tendon dysfunction is known as adult acquired flatfoot.
Adult ; Congenital Abnormalities* ; Diagnosis* ; Flatfoot* ; Humans ; Neuromuscular Diseases ; Physical Examination ; Posterior Tibial Tendon Dysfunction ; Tendons

PURPOSE: Posterior tibial tendon dysfunction (PTTD) is known as the most common cause of adult acquired flatfoot syndrome and is common in middle-aged obese women. The purpose of this study was to describe the relationship between BMI (body mass index) and early stage PTTD in Korea. MATERIALS AND METHODS: Between May 2005 and June 2006 we evaluated 42 patients (58 feet) who were diagnosed and treated for early stage PTTD. We analyzed demographic data such as sex, age, BMI, physical findings, radiologic findings and clinical results. RESULTS: All 42 patients were women; their mean age was 52.6 years. Of the 42, 77% were middle aged (40-69). Increased BMI was detected in 75% of the 42 patients. There was no statistical significance in age-matched comparisons of BMI in Korea (p>0.05), or in the correlation between BMI and progression (p=0.293). Non-obese patients had superior clinical results (p=0.017). CONCLUSION: Overweight and obesity are commonly seen in patients with early stage PTTD in Korea but there do not appear to be any significant correlation between obesity and early stage PTTD and also no significant correlation between obesity and progression to later stages.
Adult ; Body Mass Index ; Female ; Flatfoot ; Humans ; Korea ; Middle Aged ; Obesity ; Overweight ; Posterior Tibial Tendon Dysfunction

One of the common cause of the acquired adult flat foot is posterior tibial tendon insufficiency whose etiology and development is different from that of congenital flat foot, and various methods, such as synovectomy, tendon transfer, calcaneal osteotomy and arthrodesis, can be used to treat the symptoms. The sliding calcaneal osteotomy has been recently introduced by Mark Myerson. The basic concept beneath this treatment is that by displacing distal part medially after a calcaneal osteotomy, the valgus strain in hindfoot can be relieved to place the joint back to the normal position. In order to find out the effect of the sliding calcaneal soteotomy on the flat foot, we measured the changes in the strain in the upper medial spring ligament complex underneath the talonavicular joint after the operation. Four right hand four left fresh frozen cadaver foot specimens, which included the distal half of the tibia were utilized. The spring ligament was isolated with its origin at the sustentaculum tali and insertion on the navicular. At the medial calcaneus the soft tissues were periostially dissected and a small incision was made over the lateral calcaneus for the purpose of visualization. For each specimen a calibrated open liquid metal strain gauge was secured at the origin and insertion of the ligament with superglue and the gauge was sutured along the length of the superomedial portion of the spring ligament complex allowing for the gauge to slide freely. A tibial rod was driven into the intramedullary canal and the foot was always placed in the neutral plantigrade position in the test fig such that the rod was vertical at all times. A initial strain measurement was obtained with only the weight of the platform (19.6N) on the tibia. Weights were added in 7 increments to a total 472 Newton and strains were recorded. Three trials were conducted. The specimens were then removed from the rig and an oblique osteotomy were conducted. A repeated measures analysis of variance showed a significant (p < 0.001) reduction in strain following the osteotomy. To conclude, the direct measurements support the concept that a calcaneal osteotomy provides an alteration which is favorable to unloading the medial arch.
Adult ; Arthrodesis ; Cadaver ; Calcaneus ; Flatfoot ; Foot ; Hand ; Humans ; Joints ; Ligaments ; Osteotomy ; Posterior Tibial Tendon Dysfunction ; Tendon Transfer ; Tibia ; Weights and Measures

There have been many reports about surgical treatments of flexible flatfoot in children and acquired adult flatfoot deformity due to posterior tibial tendon dysfunction common in the 5th and 6th decades. However there has been a controversy for surgical treatment guideline for painful idiopathic flexible flatfoot deformities in young adults. Therefore, we present a 27-year-old female with severe painful idiopathic flexible flatfoot who was treated with medial sliding calcaneal osteotomy and subtalar arthroereisis using Kalix(R) (Newdeal SA, Vienne, France) endoprosthesis and had good clinical outcome with high patient satisfaction at 10 months follow-up postoperatively.
Adult* ; Child ; Congenital Abnormalities ; Female ; Flatfoot* ; Follow-Up Studies ; Humans ; Osteotomy* ; Patient Satisfaction ; Posterior Tibial Tendon Dysfunction ; Young Adult

PURPOSE: The isolated exercise therapy and its effect for the treatment of posterior tibial tendon dysfunction (PTTD) is not well known. The purpose of this study was to identify the clinical effect of stretching and strengthening exercise program on the patients' muscle function and range of motion, pain and gait in the management of the early stage PTTD. MATERIALS AND METHODS: From October 2006 to March 2007, 14 patients with early stage PTTD (stage I or IIa) without surgical intervention were randomly assigned into two groups and we analyzed their clinical results. All patients were female and one who have sprained the same ankle during the program and one who withdrew from the program due to her private reason were excluded. At the last, the exercise group (EG) was seven and the control group (CG) was five. Mann-Whitney U test was used for the comparison of pain, ROM, muscle power, AOFAS score and 5 minute walking test of both groups. Wilcoxon-signed rank test was used for the comparison between the pre and post exercise program in EG. RESULTS: The pain was significantly reduced in EG compare to CG and only the dorsiflexion was significantly increased in EG in the analysis of ROM. The dorsi flexion and plantar flexion power were significantly increased in EG. CONCLUSION: Our 6 weeks stretching and strengthening exercise program showed noticeably improved clinical result, and therefore it is recommended as one of the useful treatment option in the management of early stage PTTD.
Animals ; Ankle ; Exercise Therapy ; Female ; Gait ; Humans ; Muscles ; Posterior Tibial Tendon Dysfunction ; Range of Motion, Articular ; Sprains and Strains ; Walking

Acquired adult flatfoot is a deformity characterized by a decreased medial longitudinal arch and a hindfoot valgus with or without forefoot abduction. The etiologies of this deformity include posterior tibial tendon dysfunction, rheumatoid arthritis, trauma, Charcot's joint, neurologic deficit, and damage to the medial spring ligament complex or plantar fascia. Among these, posterior tibial tendon dysfunction is the most well-known cause. Although posterior tibial tendon dysfunction has been regarded as a synonym of acquired adult acquired flatfoot, failure of the ligaments supporting the arch can also result in progressive deformity even without a posterior tibial tendon problem. The authors describe the pathophysiology, diagnosis, and nonoperative treatment of acquired adult flatfoot, focusing on posterior tibial tendon dysfunction.
Adult* ; Arthritis, Rheumatoid ; Arthropathy, Neurogenic ; Congenital Abnormalities ; Diagnosis* ; Fascia ; Flatfoot* ; Humans ; Ligaments ; Neurologic Manifestations ; Posterior Tibial Tendon Dysfunction ; Tendons

OBJECTIVE: To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. MATERIALS AND METHODS: The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. RESULTS: The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. CONCLUSION: The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients.
Adolescent ; Adult ; Female ; Humans ; Korea ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Orthopedic Procedures ; Osteonecrosis/diagnosis/surgery ; Pain/pathology ; Posterior Tibial Tendon Dysfunction/diagnosis/surgery ; Tarsal Bones/*pathology/radiography/*surgery ; Tendinopathy/diagnosis/surgery ; Treatment Outcome