title: Outcome of medial displacement calcaneal osteotomy for correction of adult-acquired flatfoot.
abstract: BACKGROUND
  The results of medial displacement calcaneal osteotomy (MDCO) with flexor digitorum longus (FDL) tendon transfer were reviewed, as well as postoperative radiographic changes, to determine quantitative x-ray-based indications for MDCO with FDL tendon transfer in cases of adult-acquired flatfoot.
  
  
  METHODS
  Twenty-five patients, ages 42 to 71 years, underwent MDCO with FDL tendon transfer for stage II posterior tibial tendon dysfunction. Follow-up was 2.6 to 10.2 years. Preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF), Foot Function Index, and SF-36 scores and physical and radiographic findings were compared. Eight measures of foot alignment were obtained from weight-bearing radiographs at 3, 6, 9, and 12 months after surgery and every 6 months thereafter. Differences in scores and values over time were analyzed statistically.
  
  
  RESULTS
  Average JSSF scores improved from 59 preoperatively to 91.3 postoperatively (p < .001). The only x-ray parameters that improved significantly and showed maintenance of the surgical correction were the lateral talometatarsal (LTMT) and tibiocalcaneal (TBC) angles. With preoperative LTMT and TBC angles of >25° and >15°, respectively, correction was inadequate.
  
  
  CONCLUSIONS
  It was concluded that indications for MDCO with FDL tendon transfer in cases of adult-acquired flatfoot are a preoperative LTMT angle of <25° and hindfoot coronal alignment (TBC angle) of <15°.
authors.affiliation: Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan. h2niki@marianna-u.ac.jp
authors.forename: Hisateru
authors.initials: H
authors.lastname: Niki
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hirano
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
authors.forename: Moroe
authors.initials: M
authors.lastname: Beppu
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D005413:Flatfoot / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D037081:Posterior Tibial Tendon Dysfunction / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013709:Tendon Transfer