title: Deltoid ligament reconstruction with peroneus longus autograft in flatfoot deformity.
abstract: BACKGROUND
  Stage IV posterior tibial tendon insufficiency is characterized by the presence of valgus talar tilt in the setting of a flatfoot deformity which results from attenuation of the deltoid ligament. Correcting valgus tilt at the time of flatfoot reconstruction may prevent future collapse and the need for joint sacrificing procedures. The purpose of this study was to report the intermediate-term results of patients who underwent deltoid ligament reconstruction using a peroneus longus tendon transfer.
  
  
  METHODS
  Five patients (mean age, 67 years ± 5.3 years) who underwent flatfoot reconstruction along with deltoid ligament reconstruction using a peroneus longus autograft were evaluated at a mean of 8.9 ± 1.7 years after surgery. The FAOS, SF-36v2, and VAS surveys were administered. The correction of valgus talar tilt was determined with weightbearing radiographs of the ankle. Ankle range of motion along with standing hindfoot alignment was assessed.
  
  
  RESULTS
  The postoperative average FAOS and SF-36v2 were 68.3 (range, 55.2 to 85.0) and 75.7 (range, 40 to 92), respectively. The valgus talar tilt improved from 7.7 degrees preoperatively to 2.1 degrees postoperatively. Mean ankle range of motion was 47 degrees (range, 40 degrees to 55 degrees). Mean hindfoot alignment was 4 degrees valgus (range, 1 degree varus to 8 degrees valgus).
  
  
  CONCLUSIONS
  Deltoid ligament reconstruction using a peroneus longus tendon transfer was a useful technique for reducing tibiotalar tilt in the setting of stage IV flatfoot deformity. Correction and function were maintained at intermediate-term followup.
authors.affiliation: Hospital for Special Surgery, New York, NY 10021, USA. elliss@hss.edu
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Williams
authors.forename: Adam D
authors.initials: AD
authors.lastname: Wagshul
authors.forename: Helene
authors.initials: H
authors.lastname: Pavlov
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Deland
mesh_terms: D000368:Aged; D005260:Female; D005413:Flatfoot / Q000145:classification / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D037081:Posterior Tibial Tendon Dysfunction / Q000150:complications / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013709:Tendon Transfer; D014182:Transplantation, Autologous