Deland's 2008 JAAOS review covers the diagnosis and staged management of adult-acquired flatfoot deformity (AAFD) — a spectrum of tendon and ligament failure along the medial longitudinal arch. It addresses nonsurgical options and the specific surgical procedures indicated at each of the four deformity stages.
When a patient has >30% talar head uncoverage on standing AP radiograph, they're stage IIb — medial slide osteotomy alone likely won't be enough, but lateral column lengthening demands respect: undercorrect rather than overcorrect, because stiffness and lateral overload are common and hard to fix.
When you see lateral talar tilt on ankle films in a flatfoot patient, you're looking at stage IV deltoid failure — don't address the ankle without fully correcting the foot first.
Deland's 2008 JAAOS review covers the diagnosis and staged management of adult-acquired flatfoot deformity (AAFD) — a spectrum of tendon and ligament failure along the medial longitudinal arch. It addresses nonsurgical options and the specific surgical procedures indicated at each of the four deformity stages.
When a patient has >30% talar head uncoverage on standing AP radiograph, they're stage IIb — medial slide osteotomy alone likely won't be enough, but lateral column lengthening demands respect: undercorrect rather than overcorrect, because stiffness and lateral overload are common and hard to fix.
When you see lateral talar tilt on ankle films in a flatfoot patient, you're looking at stage IV deltoid failure — don't address the ankle without fully correcting the foot first.