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International Orthopaedics
Published in: International Orthopaedics 9/2013

01-09-2013 | Original Paper

Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematic and functional results of fifty one feet

Authors: Reinhard Schuh, Florian Gruber, Axel Wanivenhaus, Nikolaus Hartig, Reinhard Windhager, Hans-Joerg Trnka

Published in: International Orthopaedics | Issue 9/2013

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Abstract

Purpose

Stage II posterior tibial tendon dysfunction (PTTD) can be treated by flexor digitorum longus (FDL) tendon transfer and medial displacement calcaneal osteotomy (MDCO). Numerous authors have studied the clinical and radiographic results of this procedure. However, little is known about the kinematic changes. Therefore, the purpose of this study was to assess plantar-pressure distribution in these patients.

Methods

Seventy-three patients with PTTD stage II underwent FDL tendon transfer and MDCO. Plantar pressure distribution and American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed 48 months after surgery. Pedobarographic parameters included lateral and medial force index of the gait line, peak pressure (PP), maximum force (MF), contact area (CA), contact time (CT) and force-time integral (FTI).

Results

In the lesser-toe region, PP, MF, CT, FTI and CA were reduced and MF in the forefoot region was increased. These changes were statistically significant. We found statistically significant correlations between AOFAS score and loading parameters of the medial midfoot.

Conclusions

Study results reveal that FDL tendon transfer and MDCO leads to impaired function of the lesser toes during the stance phase. However, there seems to be a compensating increased load in the forefoot region.
Literature
1.
DiPaola M, Raikin SM (2007) Tendon transfers and realignment osteotomies for treatment of stage II posterior tibial tendon dysfunction. Foot Ankle Clin 12:273–285PubMedCrossRef
2.
Roth S, Roth A, Jotanovic Z et al (2013) Navicular index for differentiation of flatfoot from normal foot. Int Orthop 37:1107–1112PubMedCrossRef
3.
4.
Yeap JS, Birch R, Singh D (2001) Long-term results of tibialis posterior tendon transfer for drop-foot. Int Orthop 25:114–118PubMedCrossRef
5.
Johnson KA, Strom DE (1989) Tibialis posterior tendon dysfunc- tion. Clin Orthop 239:196–206
6.
Myerson MS (1996) Adult acquired flatfoot deformity. J Bone Joint Surg 78A:780–792
7.
Lechler P, Graf S, Koch FX et al (2012) Arthrodesis of the talonavicular joint using angle-stable mini-plates: a prospective study. Int Orthop 36:2491–2494PubMedCrossRef
8.
Joveniaux P, Harisboure A, Ohl X et al (2010) Long-term results of in situ subtalar arthrodesis. Int Orthop 34:1199–1205PubMedCrossRef
9.
Brodsky JW, Charlick DA, Coleman SC et al (2009) Hindfoot motion following reconstruction for posterior tibial tendon dysfunction. Foot Ankle Int 30:613–618PubMedCrossRef
10.
Marks RM, Long JT, Ness ME et al (2009) Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy. Gait Posture 29:17–22PubMedCrossRef
11.
Putti AB, Arnold GP, Cochrane LA et al (2008) Normal pressure values and repeatability of the Emed ST4 system. Gait Posture 27:501–505PubMedCrossRef
12.
Jansen H, Fenwick A, Droht S et al (2013) Clinical outcome and changes in gait pattern after pilon fractures. Int Orthop 37:51–58PubMedCrossRef
13.
Sinclair MF, Bosch K, Rosenbaum D et al (2009) Pedobarographic analysis following Ponseti treatment for congenital clubfoot. Clin Orthop Relat Res 467:1223–1230PubMedCrossRef
14.
Schuh R, Salzberger F, Wanivenhaus AH et al (2013) Kinematic changes in patients with double arthrodesis of the hindfoot for realignment of planovalgus deformity. J Orthop Res 31:517–524PubMedCrossRef
15.
Metaxiotis D, Accles W, Pappas A et al (2000) Dynamic pedobarography (DPB) in operative management of cavovarus foot deformity. Foot Ankle Int 21:935–947PubMed
16.
Orlin MN, McPoil TG (2000) Plantar pressure assessment. Phys Ther 80:399–409PubMed
17.
Schuh R, Hofstaetter JG, Hofstaetter SG et al (2011) Plantar pressure distribution after tibiotalar arthrodesis. Clin Biomech (Bristol, Avon) 26:620–625CrossRef
18.
Wainright WB, Spritzer CE, Lee JY et al (2012) The effect of modified Brostrom-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. Am J Sports Med 40:2099–2104PubMedCrossRef
19.
Wu WL, Su FC, Cheng YM, Huang PJ et al (2000) Gait analysis after ankle arthrodesis. Gait Posture 11:54–61PubMedCrossRef
20.
Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–5320PubMedCrossRef
21.
Hillstrom HJ, Song J, Kraszewski AP et al (2013) Foot type biomechanics part 1: Structure and function of the asymptomatic foot. Gait Posture 37:445–451PubMedCrossRef
22.
Mootanah R, Song J, Lenhoff MW et al (2013) Foot Type Biomechanics Part 2: Are structure and anthropometrics related to function? Gait Posture 37:452–456PubMedCrossRef
23.
Hughes J, Clark P, Klenerman L (1990) The importance of the toes in walking. J Bone Joint Surg Br 72:245–251PubMed
24.
Rammelt S, Grass R, Zawadski T et al (2004) Foot function after subtalar distraction bone-block arthrodesis. J Bone Joint Surg Br 86-B:659–668CrossRef
25.
Deland JT (2001) The adult acquired flatfoot and spring ligament complex. Pathology and implications for treatment. Foot Ankle Clin 6:129–135PubMedCrossRef
26.
Guyton GP, Jeng C, Krieger LE et al (2001) Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for posterior tibial tendon dysfunction: a middle-term clinical follow-up. Foot Ankle Int 22:627–632PubMed
27.
Myerson MS, Badekas A, Schon LC (2004) Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int 25:445–450PubMed
28.
Myerson MS, Corrigan J, Thompson F et al (1995) Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency: a radiological investigation. Foot Ankle Int 16:712–718PubMedCrossRef
29.
Niki H, Hirano T, Okada H et al (2012) Outcome of medial displacement calcaneal osteotomy for correction of adult-acquired flatfoot. Foot Ankle Int 33:940–946PubMedCrossRef
30.
Wacker JT, Hennessy MS, Saxby TS (2002) Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of tibialis posterior. Three- to five-year results. J Bone Joint Surg Br 84:54–58PubMedCrossRef
Metadata
Title
Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematic and functional results of fifty one feet
Authors
Reinhard Schuh
Florian Gruber
Axel Wanivenhaus
Nikolaus Hartig
Reinhard Windhager
Hans-Joerg Trnka
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 9/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2071-6

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