Coetzee and Castro review the biomechanical rationale and specific indications for each hindfoot procedure used in PTTD — from Achilles lengthening and medializing calcaneal osteotomy to lateral column lengthening, subtalar fusion, and triple arthrodesis — providing an algorithm for stage II disease and quantitative thresholds to guide procedure selection.
When planning PTTD surgery, use the 10–12° forefoot varus threshold and the 80% vs. <20% subtalar motion rule to choose between lateral column lengthening and subtalar fusion — then always assess whether Achilles contracture needs to be addressed concurrently, regardless of which bony procedure you select.
Coetzee and Castro review the biomechanical rationale and specific indications for each hindfoot procedure used in PTTD — from Achilles lengthening and medializing calcaneal osteotomy to lateral column lengthening, subtalar fusion, and triple arthrodesis — providing an algorithm for stage II disease and quantitative thresholds to guide procedure selection.
When planning PTTD surgery, use the 10–12° forefoot varus threshold and the 80% vs. <20% subtalar motion rule to choose between lateral column lengthening and subtalar fusion — then always assess whether Achilles contracture needs to be addressed concurrently, regardless of which bony procedure you select.