The Hyperblog

Venue - Stepping Hill Hospital

Leader - Mr R Dalal

Topic - adult acquired flatfoot and tibialis posterior tendonopathy

Aiming to cover

• the changing understanding of this condition
• pathology
• clinical assessment
• imaging
• surgical and non-surgical treatment

The adult acquired flatfoot is another good exam “short case” - you need to be able to demonstrate the key signs confidently. Once seen as basically a chronic tendon rupture, it is now seen as a biomechanically complex deformity with almost as many abnormalities in the peritalar ligaments as the tibialis posterior tendon.

Suggested reading

The Hyperbook chapter was last revised just over a year ago, with no major changes since then.

Myerson MS et al. Treatment of stage 2 posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int 2004; 25:445-50

Deland JT et al. Posterior tibial tendon insufficiency: which ligaments are involved?. Foot Ankle Int 2005; 26:427-35

Alvarez RG et al. Stage I and II posterior tibia tendon dysfunction treated by a structured non-operative management program. Foot Ankle Int 2006; 27:2-8

Johnson KA, Strom DE. Tibialis  posterior tendon dysfunction. CORR 1989; 239:196-206. Probably worth reading as a historical “where we came from” document, and to marvel how a paper can become a classic without actually containing any data, and stating at least one thing that everyone agrees is untrue!