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Hu Y, Wang Y, Huang Z, Li Z, Xu W, Zhou D, Zhang N. A Novel Anatomic Reconstruction for Posterior Tibialis Tendon in Treatment of Flexible Adult-Acquired Flatfoot Deformity. Orthop Surg 2022; 14:1428-1437. [PMID: 35686536 PMCID: PMC9251276 DOI: 10.1111/os.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To present a novel approach for the anatomic reconstruction of the posterior tibialis tendon (PTT) in restoring plantar insertions and evaluate its efficiency in treating flexible adult-acquired flatfoot deformity (AAFD) caused by PTT dysfunction. METHODS For AAFD treatment, a novel PTT reconstruction method was presented. The current study involved 16 patients, including three men, and 13 women, from August 2017 to July 2019. The mean age was 43.2 ± 15.1 years (21-64 years). The innovative PTT repair method was used on all patients. The treatment involved performing a traditional Flexor Digitorum Longus (FDL) transfer in the navicular tuberosity and suturing the plantar insertions to FDL as tension was applied to tighten the plantar structures of the foot. The results were retrospectively analyzed. The clinical outcome was assessed using the pain visual analogue scale (VAS), the satisfaction VAS, and the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AH). Isokinetic testing was performed using a dynamometer at 60°/s and 120°/s for inversion/eversion and plantarflexion/dorsiflexion, respectively, to determine the mean peak torque. Radiographic measurements were employed to assess the outcomes. RESULTS Bone surgeries combined with the modified anatomic PTT reconstruction were performed on patients with medializing calcaneal osteotomy in 12 (75%) patients and subtalar joint fusion in four (25%) patients. The branch linking to the plantar insertions was detected in every case, with an average width of 3.5 ± 0.8 mm (3.1-4.3 mm). All patients were followed up for the mean of 16.8 ± 1.8 months (range, 15-20 months). The average postoperative functional scores, including pain VAS, satisfaction VAS, total AOFAS-AH, and all AOFAS-AH sub-scales, steadily improved during the follow-up. In the last follow-up, isokinetic testing revealed no loss of plantarflexion strength (p = 0.350 and 0.098) and significant improvement in the inversion strength (p = 0.007 and 0.008) in the operated ankles at 60°/s and 120°/s. Radiographic outcomes, particularly the talar head uncovering, improved significantly after more than a year (p < 0.001 for all). CONCLUSIONS The novel technique for PTT reconstruction in restoring the plantar insertions serves as an effective procedure in treating AAFD caused by PTT dysfunction in terms of delivering a consistent improvement in ankle inversion strength, medial longitudinal arch restoring, and satisfactory clinical outcomes.
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Affiliation(s)
- Yong Hu
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, P. R. China
| | - Yifan Wang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, P. R. China
| | - Zheng Huang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, P. R. China
| | - Zhengxun Li
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, P. R. China
| | - Wenpeng Xu
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, P. R. China
| | - Dongsheng Zhou
- Department of Orthopaedic, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Ning Zhang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, P. R. China
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Osman AE, El-Gafary KA, Khalifa AA, El-Adly W, Fadle AA, Abubeih H. Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study. Foot (Edinb) 2021; 47:101798. [PMID: 33957531 DOI: 10.1016/j.foot.2021.101798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications. PATIENT AND METHODS 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported. RESULTS At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion. CONCLUSION LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
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Affiliation(s)
- Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | | | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
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LiMarzi GM, Scherer KF, Richardson ML, Warden DR, Wasyliw CW, Porrino JA, Pettis CR, Lewis G, Mason CC, Bancroft LW. CT and MR Imaging of the Postoperative Ankle and Foot. Radiographics 2017; 36:1828-1848. [PMID: 27726748 DOI: 10.1148/rg.2016160016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging. ©RSNA, 2016.
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Affiliation(s)
- Gary M LiMarzi
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Kurt F Scherer
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Michael L Richardson
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - David R Warden
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher W Wasyliw
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Jack A Porrino
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher R Pettis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Gideon Lewis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher C Mason
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Laura W Bancroft
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
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