1. Case for small group discussion
Flexible flatfoot
Case for small group discussion
Learning points:
True all American
R/o tarsal coalition
May take bone graft from the calcaneus
AOTrauma—Foot & Ankle
Module 9: Acquired flatfoot deformity
Arthur Manoli II, US

2. Case description 16-year-old female snowboarder
Painful feet, right > left
Failed orthotics, stretching
Pain on subtalar movement

3. Preoperative x-ray

4. Preoperative x-ray

5. Preoperative CT scans Rule out tarsal coalition (if uncertain)
Talonavicular and talocalcaneal

6. Surgical plan Tendon Achilles lengthening (TAL)
Double calcaneal osteotomy with bone graft for the Evans, first metatarsal (MT) harvested from the medial calcaneal osteotomy (or iliac crest)
Flexor digitorum longus (FDL) transfer to Tibialis Posterior
Medial column procedure if needed:
First TMT fusion in plantar flexion
Alternatively, MT osteotomy
“All American”

7. Bone graft harvest from calcaneus
Do the Evans first so you know how much bone graft to harvest

8. 6 months postoperative

9. 6 months postoperative
6 mos postop

10. Take-home messages
Always rule out tarsal coalition prior to a flatfoot reconstruction
Bone graft may be harvested from the medializing calcaneal osteotomy
If the Evans procedure does not give enough correction, add a medial column plantar flexion or stabilizing procedure
Consider gastrocnemius lengthening if equinus present