title: Shell brace for stage II posterior tibial tendon insufficiency.
abstract: BACKGROUND
  The nonoperative treatment of posterior tibial tendon insufficiency (PTTI) can lead to unsatisfactory functional results. Short-term results are available but the impact on the evolution of the deformity is not known. To address these problems, a new brace for the flexible Stage II deformity was developed, and midterm followup was obtained.
  
  
  METHODS
  In a prospective case series, eighteen patients (mean age 64.2 years; range, 31 to 82; four male, 14 female) with flexible Stage II PTTI were fitted with the new custom-molded foot orthosis. At latest followup of a mean of 61.4 (range, 20 to 87) months, functional results were assessed with the AOFAS ankle hindfoot score and clinical or radiographic progression was recorded.
  
  
  RESULTS
  The score improved significantly from a mean of 56 points (range, 20 to 64) to a mean of 82 points (range, 64 to 100, p < 0.001). Three patients (3/18, 16%) had a clinical progression to a fixed deformity (Stage III) and a radiographic increase of their deformity. All the other patients were satisfied with the brace's comfort and noted an improvement in their mobility. Complications were seen in three patients (3/18, 16%), and consisted of the development of calluses.
  
  
  CONCLUSIONS
  The "shell brace" is a valuable option for nonoperative treatment of the flexible Stage II PTTI. Hindfoot flexibility was conserved throughout the observation period in all but three patients. Functional outcome and patient acceptance was above average. Problems were few, and closely associated with a progression to a fixed, Stage III deformity.
authors.forename: Fabian
authors.initials: F
authors.lastname: Krause
authors.forename: Adrian
authors.initials: A
authors.lastname: Bosshard
authors.forename: Oliver
authors.initials: O
authors.lastname: Lehmann
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001915:Braces; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D037081:Posterior Tibial Tendon Dysfunction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D016896:Treatment Outcome; D016138:Walking