1. Case for small group discussion
Flatfoot deformity
Case for small group discussion
Stage II flatfoot reconstruction—all Australian
AOTrauma—Foot & Ankle
Module 9: Acquired flatfoot deformity
Andrew Wines, AU

2. Case description 55-year-old woman Progressive flatfoot deformity
Pain over the posterior tibial tendon
Physical examination shows a mobile hindfoot

4. Heel cord lengthening Triple cut:
Medial, lateral, medial distal to proximal
Quick and easy
Rupture
Gastrocnemius lengthening

5. Medializing osteotomy
Medial calcaneal slide

6. Medializing osteotomy—intraoperative x-rays

7. Sinus tarsi implant insertion
Internal orthotic:
Decreases tendency of talus to rotate medially and plantarward
Improves talonavicular coverage

9. Flexor digitorum longus (FDL) tendon transfer
FDL harvested at knot of Henry
Weave through tibialis posterior tendon
Inserted into tuberosity of navicular:
Interosseous suture

10. Postoperative management
Splint for 2 weeks:
Anticoagulation therapy (LMWH)
Walking boot for 4 weeks:
Weight bearing as tolerated
ROM exercises
Physical therapy
LMWH—Low molecular weight heparin

11. Treatment—late stage II disease
Arthroereisis (sinus tarsi spacer)

12. Complications Displacement Overcorrection (overstuffing)
Undercorrection
Pain

13. Take-home messages
Achilles lengthening must be considered in the treatment of flatfoot
Subtalar arthroereisis (with a sinus tarsi implant or screw) may be an alternative or an augmentation to a medial displacement calcaneal osteotomy
Be aware of sinus tarsi spacer complications