This report reviews the information and ideas presented at recent meetings of the American Orthopaedic Foot and Ankle Society (AOFAS) as well as studies presented at the annual meeting of the American Academy of Orthopaedic Surgeons and at other subspecialty meetings. Pertinent points from articles in Foot and Ankle International and other journals are also highlighted in an effort to present an overview of the major advances and new concepts in foot and ankle surgery.
Posterior Tibial Tendinitis
Dysfunction of the posterior tibial tendon continues to be intensely investigated. In stage 1, posterior tibial tendinitis is characterized by inflammation. In stage 2, the posterior tibial tendon is elongated and the foot assumes the typical planovalgus posture. Because the insertion of the gastrocnemius tendon on the calcaneal tubercle in this posture is lateral to the axis of the subtalar joint, the hindfoot is everted. The hindfoot, in this stage, fails to invert with attempted single-leg toe-rises, but the hindfoot joints remain supple. Hindfoot and midfoot stiffness and arthritis progress in stage 3. Soft-tissue reconstruction is not possible at this stage, and triple arthrodesis is generally necessary. Most current discussion has focused on stage-2 reconstruction techniques, and these generally involve tendon transfers to the medial navicular to reestablish the function of the posterior tibial tendon. Because the ligamentous support of the medial longitudinal arch is attenuated and the muscle grafts cannot provide comparable stability, procedures on osseous structures are necessary to reduce the mechanical advantage of the deforming muscles.
Flexor digitorum longus transfer with medial calcaneal osteotomy is currently a widely used technique. Guyton et al.1 reviewed a series of these reconstructions at a mean of thirty-two months after surgery. Although radiographic alignment was improved, only one-half of the patients noticed the improvement clinically. Pain relief was rated as good or excellent by 91% …
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