Tibialis Posterior reconstruction for pes planus, using FDL transfer and Arthrex Biotenodesis screw
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The operation described using a Flexor Digitorum Longus(FDL) transfer, spring ligament plication and medialising calcaneal osteotomy is the classic reconstruction for a grade 2 (flexible ) flat foot due to Tibialis Posterior dysfunction.
Tibialis Posterior dysfunction is typically a condition of middle age and onwards in which conservative management with orthotics and physiotherapy is usually the first line of management and often successful (in approximately two thirds of cases).
Surgical correction of the flexible flat foot using the FDL transfer with calcaneal osteotomy (and other procedures) results in high patient satisfaction rates and symptomatic relief but with a slightly lower incidence of maintained correction of the pes planus deformity. A proportion of patients, though improved, still require the use of a corrective orthotic.
OrthOracle readers will also find of interest the following associated instructional operative techniques:
Pes Planus correction with FDL transfer, Calcaneal osteotomy and Wright Bioarch arthroresis screw
Calcaneal osteotomy with OrthoSolutions FRS Locking Plate
Calcaneal osteotomy (open technique using Atkins approach)
Tibialis posterior tendon debridement
Author: Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.
In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu
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