title: Functional results of posterior tibial tendon reconstruction, calcaneal osteotomy, and gastrocnemius recession.
abstract: BACKGROUND
  This study aimed to assess and provide prospective outcome data following reconstruction of Stage II posterior tibial tendon insufficiency, as well as evaluate the effect of reconstruction with gastrocnemius recession on plantarflexion strength.
  
  
  METHODS
  A prospective evaluation of 24 patients undergoing reconstruction for Stage II posterior tibial tendon insufficiency was granted IRB approval. The reconstructive procedures consisted of a flexor digitorum longus transfer, medial displacement calcaneal osteotomy, lateral column lengthening, and gastrocnemius recession. Patients were asked to complete multiple outcome measures preoperatively, 6 months, 1 year, and 2 years postoperatively. A dynamometer was utilized to evaluate peak torque plantarflexion preoperatively, 6 months, and 1 year postoperatively.
  
  
  RESULTS
  In the study, 14 patients completed preoperative surveys, and 23 patients had 2-year followup. Patients were highly satisfied with the results of their surgery. All outcome measures showed statistically significant improvement. Improvement was seen at 6 months, but results continued to improve at the 1-year mark. By the second year, improvement largely reached a plateau. Biodex testing showed no loss of plantarflexion strength after reconstruction and gastrocnemius recession.
  
  
  CONCLUSIONS
  Reconstruction of the flexible adult acquired flatfoot with FDL transfer, double calcaneal osteotomy, and gastrocnemius recession yielded excellent functional results for the treatment of Stage II posterior tibial tendon insufficiency. Plantarflexion weakness was not found to be a concern. A good functional outcome can be anticipated after the early postoperative period. However, it should be expected to take at least 1 year for maximal benefit.
authors: Muir Orthopaedic Specialists, Orthopaedic Surgery, Walnut Creek, CA 94598, USA. joexkou@gmail.com
authors: Joseph X
authors: JX
authors: Kou
authors: Mamtha
authors: M
authors: Balasubramaniam
authors: Matthew
authors: M
authors: Kippe
authors: Paul T
authors: PT
authors: Fortin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000601:surgery*; D010027:Osteotomy; D017060:Patient Satisfaction; D037081:Posterior Tibial Tendon Dysfunction / Q000145:classification / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome