This review by Bluman and Myerson examines Stage IV posterior tibial tendon rupture — the most advanced form of adult acquired flatfoot — in which hindfoot valgus deformity progresses to involve the tibiotalar joint through deltoid ligament insufficiency. The paper addresses how to classify, diagnose, and surgically manage this rare but complex condition.
When you see a flatfoot patient with tibiotalar valgus on standing radiographs, manually stress the ankle under fluoroscopy before planning surgery — if the deformity corrects (Stage IV-A), joint-sparing reconstruction with allograft deltoid repair is on the table; if it doesn't (Stage IV-B), plan tibiotalocalcaneal or pantalar fusion.
Never reconstruct the deltoid without first realigning the foot, or the repair will fail.
This review by Bluman and Myerson examines Stage IV posterior tibial tendon rupture — the most advanced form of adult acquired flatfoot — in which hindfoot valgus deformity progresses to involve the tibiotalar joint through deltoid ligament insufficiency. The paper addresses how to classify, diagnose, and surgically manage this rare but complex condition.
When you see a flatfoot patient with tibiotalar valgus on standing radiographs, manually stress the ankle under fluoroscopy before planning surgery — if the deformity corrects (Stage IV-A), joint-sparing reconstruction with allograft deltoid repair is on the table; if it doesn't (Stage IV-B), plan tibiotalocalcaneal or pantalar fusion.
Never reconstruct the deltoid without first realigning the foot, or the repair will fail.