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Mark S Myerson - One of the best experts on this subject based on the ideXlab platform.

  • Posterior Tibial Tendon tear after 4 cortex syndesmotic screw fixation a case report and literature review
    Journal of Orthopaedic Trauma, 2012
    Co-Authors: John Y Kwon, John T Campbell, Mark S Myerson
    Abstract:

    We describe a previously unreported problem of a patient who underwent errant 4-cortex syndesmotic screw fixation with resultant Posterior Tibial Tendon tear necessitating removal of hardware and repair of a Tendon tear.

  • stage iv Posterior Tibial Tendon rupture
    Foot and Ankle Clinics of North America, 2007
    Co-Authors: Eric M Bluman, Mark S Myerson
    Abstract:

    Adult acquired flatfoot deformity progresses through well defined stages as set out by Johnson and Strom. Myerson modified this classification system with the addition of a fourth, more advanced stage of the disease. This stage describes the involvement of the tibiotalar joint in addition to the hindfoot malalignment seen in stages II and III. This most advanced stage is comprised of a hindfoot valgus deformity, resulting from degeneration of the Posterior Tibial Tendon, with associated valgus tilting of the talus within the mortise. The deformity at the tibiotalar joint may or may not be rigid. Although rigid deformities are still best treated with fusions of the ankle and hindfoot, supple tibiotalar deformity may be treated with joint sparing procedures involving reconstructive procedures of the foot and deltoid ligaments.

  • instructional course lectures the american academy of orthopaedic surgeons adult acquired flatfoot deformity treatment of dysfunction of the Posterior Tibial Tendon
    Journal of Bone and Joint Surgery American Volume, 1996
    Co-Authors: Mark S Myerson
    Abstract:

    Acquired flatfoot deformity caused by dysfunction of the Posterior Tibial Tendon is a common clinical problem. Treatment, which depends on the severity of the symptoms and the stage of the disease, includes non-operative options, such as rest, administration of anti-inflammatory medication, and immobilization, as well as operative options, such as Tendon transfer, calcaneal osteotomy, and several methods of arthrodesis. The Posterior Tibial muscle forms part of the deep Posterior compartment of the calf. It originates from the proximal third of the tibia and the interosseous membrane and passes immediately Posterior to the medial malleolus, where it changes direction acutely23. A groove in the posteromedial aspect of the distal part of the tibia holds the Posterior Tibial Tendon but is not deep enough to keep the Tendon from bow-stringing or dislocating after an injury45. The flexor retinaculum, which is adjacent to the medial malleolus, tethers the Tendon and keeps it in the groove, preventing dislocation. Distally, this retinaculum blends with the sheath of the Posterior Tibial Tendon and the superficial deltoid ligament. The Posterior Tibial Tendon does not have a mesotenon, and there is an area of relative hypovascularity immediately distal to the medial malleolus that may contribute to degenerative changes of the Tendon15. The Posterior Tibial Tendon divides anterior to the tuberosity of the navicular. An anterior slip, which is in direct continuity with the main Tendon, inserts onto the tuberosity of the navicular, the inferior aspect of the capsule of the medial naviculocuneiform joint, and the inferior surface of the medial cuneiform. A second slip attaches to the plantar surfaces of the middle and lateral cuneiforms and the cuboid as well as to the bases of the corresponding metatarsals56. The Posterior Tibial Tendon passes Posterior to the axis of the ankle …

  • treatment of Posterior Tibial Tendon dysfunction with flexor digitorum longus Tendon transfer and calcaneal osteotomy
    Orthopedics, 1996
    Co-Authors: Mark S Myerson, John Corrigan
    Abstract:

    We treated 32 patients with stage-II Posterior Tibial Tendon dysfunction with calcaneal osteotomy and flexor digitorum longus Tendon transfer. These 32 patients (29 women, 3 men) had an average age of 58 years (range, 46 to 73 years) and had been symptomatic for an average of 2.5 years (range, 1 to 8 years) before surgical correction. The indication for surgery was the presence of medial foot pain refractory to nonoperative treatments, including shoewear modifications, orthoses, and bracing. All patients were examined at a mean of 20 months (range, 14 to 48 months) after surgery. Functional and radiographic examinations were performed for each patient and the American Orthopaedic Foot and Ankle Society (AOFAS) foot rating scale was used. Of the 32 patients, 30 were satisfied with the outcome of surgery, had improved function, and exhibited radiographic correction of the foot deformity. The AOFAS score improved from a preoperative mean of 48 points (range, 23 to 76) to a postoperative mean of 84 points (range, 68 to 92). In one patient, treatment failed, necessitating a triple arthrodesis for worsening deformity. The short-term results of this procedure are encouraging. Most patients (94%) experienced pain relief, had improvement in the arch of the foot, and were able to wear regular shoes without orthotic support. In order to correct deformity and provide substantial relief of foot pain and dysfunction, a medial translational calcaneal osteotomy was performed in addition to a flexor digitorum longus Tendon transfer for management of stage-II Posterior Tibial Tendon dysfunction.

  • Tendon transfer combined with calcaneal osteotomy for treatment of Posterior Tibial Tendon insufficiency a radiological investigation
    Foot & Ankle International, 1995
    Co-Authors: Mark S Myerson, Francesca M Thompson, John Corrigan, Lew C Schon
    Abstract:

    We present the radiographic results after flexor digitorum longus Tendon transfer combined with a medial displacement calcaneal osteotomy for the treatment of Posterior Tibial Tendon insufficiency. Eighteen patients with Posterior Tibial Tendon insufficiency were reviewed from 12 to 26 months after surgery. The 15 women and 3 men had a mean age of 54 years (range, 38–72 years). The talar-first metatarsal and talonavicular coverage angles were measured before and after surgery on the anteroPosterior weightbearing radiographs. The mean preoperative talar-first metatarsal and talonavicular coverage angles were 21° (range, 3–45°) and 34° (range, 0–55°), respectively. The mean postoperative values for these angles were 8.5° (range, 0–35°) and 21° (range, −30–45°), respectively. The mean talar-first metatarsal angle decreased from 21° to 8.5°, a mean improvement of 12.5°, and the mean talonavicular coverage angle decreased from 34° to 21°, a mean improvement of 13°. On the lateral weightbearing radiographs, the...

Arthur Manoli - One of the best experts on this subject based on the ideXlab platform.

  • intermediate follow up on the double osteotomy and Tendon transfer procedure for stage ii Posterior Tibial Tendon insufficiency
    Foot & Ankle International, 2001
    Co-Authors: Susan Moseirlaclair, Gregory Pomeroy, Arthur Manoli
    Abstract:

    62 patients with 28 pes planovalgus feet secondary to Johnson stage 2 Posterior Tibial Tendon insufficiency were treated with flexor digitorum longus Tendon transfer, lateral column lengthening, me...

  • Posterior Tibial Tendon insufficiency: diagnosis and treatment.
    The Journal of the American Academy of Orthopaedic Surgeons, 1999
    Co-Authors: Timothy C. Beals, Gregory C. Pomeroy, Arthur Manoli
    Abstract:

    Posterior Tibial Tendon insufficiency is the most common cause of acquired adult flatfoot deformity. Although the exact etiology of the disorder is still unknown, the condition has been classified, on the basis of clinical and radiographic findings, into four stages. In stage I, there is no notable clinical deformity; patients usually present with pain along the course of the Tendon and evidence of local inflammatory changes. Stage II is characterized by a dynamic deformity of the hindfoot. Stage III involves a fixed deformity of the hindfoot and typically also a fixed forefoot supination deformity but no obvious evidence of ankle abnormality. In stage IV, ankle involvement is secondary to long-standing fixed hindfoot deformities. The initial treatment of patients in any stage should be nonoperative, with immobilization, a nonsteroidal anti-inflammatory drug, and perhaps an orthotic device. Corticosteroid injections continue to be controversial. When nonoperative management fails, the treatment options consist of soft-tissue procedures alone or in combination with osteotomy or arthrodesis. Stage I insufficiency is generally treated with debridement and tenosynovectomy. Soft-tissue transfer does not appear to correct the underlying deformity in stage II disease; however, there is growing interest in joint-sparing operations that attempt to compensate for the underlying deformities with osteotomies or arthrodeses, supplemented with dynamic transfers to replace the insufficient Posterior Tibial Tendon. Subtalar, double, or triple arthrodesis is the procedure of choice for stage III disease, frequently in conjunction with heel-cord lengthening. Tibiocalcaneal arthrodesis or pantalar arthrodesis is most commonly used to treat stage IV disease.

  • a new operative approach for flatfoot secondary to Posterior Tibial Tendon insufficiency a preliminary report
    Foot & Ankle International, 1997
    Co-Authors: Gregory Pomeroy, Arthur Manoli
    Abstract:

    The treatment of Johnson stage 2 Posterior Tibial Tendon insufficiency remains controversial. Because the deformities remain flexible in stage 2, bony osteotomies are preferable over fusion operations. It is our contention that operative intervention should address all of the components of the pes planovalgus deformity that exists in stage 2 disease. Seventeen patients with 20 cases of stage 2 Posterior Tibial Tendon insufficiency were treated with heel cord lengthening, flexor digitorum longus to medial cuneiform Tendon transfer, lateral column lengthening, and medial displacement calcaneal osteotomy. Preoperative, postoperative, and final radiographs while standing were analyzed to determine radiographic correction of the deformities. In addition, the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale was applied to all patients before surgery and at 6-month intervals after surgery. Currently, the average follow-up is 17.5 months. The average foot rating score preoperatively was 51.4 and has improved to 82.8. Radiograph measurements have demonstrated statistically significant correction of the pes planovalgus deformity, as well as maintenance of the correction to date. It is our conclusion that this combination of surgical procedures provides correction of the symptomatology and deformity associated with stage 2 Posterior Tibial Tendon insufficiency. The long-term result of the procedure is unknown.

  • a new operative approach for flatfoot secondary to Posterior Tibial Tendon insufficiency a preliminary report
    Foot & Ankle International, 1997
    Co-Authors: Gregory Pomeroy, Arthur Manoli
    Abstract:

    The treatment of Johnson stage 2 Posterior Tibial Tendon insufficiency remains controversial. Because the deformities remain flexible in stage 2, bony osteotomies are preferable over fusion operations. It is our contention that operative intervention should address all of the components of the pes planovalgus deformity that exists in stage 2 disease. Seventeen patients with 20 cases of stage 2 Posterior Tibial Tendon insufficiency were treated with heel cord lengthening, flexor digitorum longus to medial cuneiform Tendon transfer, lateral column lengthening, and medial displacement calcaneal osteotomy. Preoperative, postoperative, and final radiographs while standing were analyzed to determine radiographic correction of the deformities. In addition, the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale was applied to all patients before surgery and at 6-month intervals after surgery. Currently, the average follow-up is 17.5 months. The average foot rating score preoperatively was 5...

Jonathan T Deland - One of the best experts on this subject based on the ideXlab platform.

  • comparison of deformity with respect to the talus in patients with Posterior Tibial Tendon dysfunction and controls using multiplanar weight bearing imaging or conventional radiography
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Amgad M Haleem, Jonathan T Deland, Helene Pavlov, Eric A Bogner, Carolyn M Sofka, Scott J Ellis
    Abstract:

    Background: Posterior Tibial Tendon dysfunction varies in location and severity. Weight-bearing radiographs have been validated to assess Posterior Tibial Tendon dysfunction, yet their two-dimensional nature and the inability of the patients to achieve full weight-bearing during acquisition are limitations. Multiplanar modified sectional weight-bearing imaging is a novel modality, yielding computed tomography-like images compared with radiographs, yet with true weight-bearing, shorter acquisition time, and lower radiation. The aim of this study was to test two hypotheses: first, multiplanar weight-bearing imaging would localize deformity with respect to the talus in patients with Posterior Tibial dysfunction compared with controls, and second, multiplanar weight-bearing imaging would correlate with specific radiographic parameters of Posterior Tibial Tendon dysfunction on weight-bearing radiographs. Methods: Weight-bearing radiographs and multiplanar modified sectional weight-bearing images of the foot and ankle were made for twenty-three patients with flexible Posterior Tibial Tendon dysfunction. Ten patients with imaging for unrelated pathological conditions served as controls. Thirteen radiographic parameters on the transverse, sagittal, and coronal views of multiplanar weight-bearing imaging in the study group were evaluated and compared with those in the control group. The same parameters on standing weight-bearing radiographs of patients in the study group were compared with those in the control group. Results: Significant differences between study and control groups were found on multiplanar weight-bearing imaging for six of thirteen radiographic parameters (p < 0.05), notably the sagittal talonavicular angle as well as sagittal and transverse talar-first metatarsal angles (p = 0.027, p = 0.003, and p = 0.004, respectively). However, only one parameter on weight-bearing radiographs (lateral talar-first metatarsal angle) reached significance (p < 0.05). Correlation showed excellent, very good, and good agreement between both imaging modalities for three, two, and five parameters, respectively. Conclusions: Deformity with respect to the talus in Posterior Tibial Tendon dysfunction is multifactorial, but was notably seen at the talonavicular joint in the sagittal plane with both modalities. Good to excellent agreement was found between weight-bearing radiographs and multiplanar weight-bearing images for many parameters; however, a greater number of significant differences was found between the flatfoot and control groups for multiplanar weight-bearing images. This implies a potential role for multiplanar modified sectional weight-bearing imaging as a more informative tool to assess Posterior Tibial Tendon dysfunction in the physiological, full weight-bearing position. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  • functional outcome after surgical reconstruction of Posterior Tibial Tendon insufficiency in patients under 50 years
    Foot & Ankle International, 2008
    Co-Authors: Nazzar Tellisi, M Lobo, Martin J Omalley, John G Kennedy, Andrew J Elliott, Jonathan T Deland
    Abstract:

    Background:Procedures utilized to address the flatfoot in this study included medializing calcaneal osteotomy, Posterior Tibial Tendon reconstruction with flexor digitorum longus Tendon transfer, and in patients with more severe deformity, lateral column lengthening. We evaluated patients age 50 and less at the time of surgery, who underwent surgical reconstruction for Stage 2 Posterior Tibial Tendon dysfunction. Pre- and postoperative activity levels were evaluated to assess the effect of surgical reconstruction in the younger patient.Materials and Method:Thirty-four feet in 30 patients (11 male, 19 female) with an average age of 41.2 (range, 17 to 50) years had surgery between 1997 and 2004. All feet were examined at an average followup of 44.5 (range, 24 to 65) months and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score and SF-36 score.Results:The average preoperative AOFAS-Score was 53.1 ± 14.5 points and 83.2 ± 12.2 points at final postoperative followup. The...

  • Posterior Tibial Tendon insufficiency results at different stages
    HSS Journal, 2006
    Co-Authors: Jonathan T Deland, Ilhoon Sung, Martin J Omalley, Alexandra E Page, David John Inda, Steven Choung
    Abstract:

    The results of surgical treatment of Posterior Tibial Tendon insufficiency (PTTI) may be different at different stages of the disease. No single study has compared the results at different stages. This comparison can be helpful to the patient and physician if the patient asks “What if I wait and the disease progresses, how will my results be different?” A preliminary study comparing results for stage IIa, stage IIb (advanced stage II), and stage III was performed followed by a larger study comparing IIa and IIb with 26 and 22 patients, respectively. American Orthopaedic Foot and Ankle Society (AOFAS) outcome scores as well as radiographs and functional questions were used. Nearly all patients, regardless of stage, felt they were helped by surgical treatment. However, the lowest AOFAS score was in stage III, the most advanced stage investigated in this study. In comparing stage IIa and IIb patients, stage IIb patients had a statistically higher incidence of lateral discomfort. Although statistically significant differences were not found in all comparisons, this study suggests that the results of surgical treatment for PTTI declines with increasing stage or severity of disease.

  • Posterior Tibial Tendon insufficiency which ligaments are involved
    Foot & Ankle International, 2005
    Co-Authors: Jonathan T Deland, Richard J De Asla, Ilhoon Sung, Lauren A Ernberg, Hollis G Potter
    Abstract:

    Background: The pathology manifested in Posterior Tibial Tendon insufficiency (PTTI) is not limited to the Posterior Tibial Tendon. The association of ligament failure with deformity has been discussed in numerous publications, but extensive documentation of the structures involved has not been performed. The purpose of this observational study was to identify the pattern of ligament involvement using standarized, high-resolution magnetic resonance imaging (MRI) in a series of 31 consecutive patients diagnosed with PTTI compared to an age matched control group without PTTI. Method: The structures evaluated by MRI were the Posterior Tibial Tendon, superomedial and inferomedial components of the spring ligament complex, talocalcaneal interosseous ligament, long and short plantar ligaments, plantar fascia, deltoid ligament, plantar naviculocuneiform ligament, and tarsometatarsal ligaments. Structural derangement was graded on a five-part scale (0 to IV) with level 0 being normal and level IV indicating a tea...

  • outcome following addition of peroneus brevis Tendon transfer to treatment of acquired Posterior Tibial Tendon insufficiency
    Foot & Ankle International, 2001
    Co-Authors: Suzette J Song, Jonathan T Deland
    Abstract:

    The flexor digitorum longus, the Tendon most often used for transfer in Posterior Tibial Tendon insufficiency, is one-half to one-third the size of the Posterior Tibial Tendon. Occasionally it may be particularly small or may have been previously used for transfer. In these cases, the senior author has felt that the addition of a transfer of the Peroneus Brevis (PBr) Tendon may be helpful in maintaining sufficient Tendon and muscle mass to rebalance the foot. Thirteen patients who underwent this procedure were retrospectively identified and matched by age and length of follow-up to patients who underwent a more standard Tendon transfer operation minus the addition of the PBr transfer. Pain and functional status were then assessed by the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale. Each patient was tested by an independent physical therapist to evaluate inversion and eversion strength.The mean duration of follow-up was 20.6 months (12 to 34 months). The average AOFAS score of ...

Eric P Salathe - One of the best experts on this subject based on the ideXlab platform.

  • a biomechanical analysis of Posterior Tibial Tendon dysfunction medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot
    Clinical Biomechanics, 2009
    Co-Authors: George A Arangio, Eric P Salathe
    Abstract:

    Abstract Background Biomechanical models have been used to study stress in the metatarsals, subtalar motion, lateral column lengthening and subtalar arthroereisis. Posterior Tibial Tendon dysfunction has been associated with increased loads in the arch of the acquired flat foot. We examine whether a 10 millimeter (mm) medial displacement calcaneal osteotomy and flexor digitorum longus transfer to the navicular reduces these increased loads in the flat foot. Methods The response of a normal foot, a foot with Posterior Tibial Tendon dysfunction, and a flat foot to an applied load of 683 Newton was analyzed using a multi-segment biomechanical model. The distribution of load on the metatarsals, the moment about each joint, the force on each of the plantar ligaments and the muscle forces were computed. Findings Posterior Tibial Tendon dysfunction results in increased load on the medial arch, which may cause the foot to flatten. A 10 mm medial displacement calcaneal osteotomy substantially decreases the load on the first metatarsal and the moment at the talo-navicular joint and increases the load on the fifth metatarsal and the calcaneal-cuboid joint. Adding the flexor digitorum longus transfer to the medial displacement calcaneal osteotomy has only a small effect on the flattened foot. Interpretation Our biomechanical analysis illustrates that when the foot becomes flat, the force on the talo-navicular joint increases substantially from its value for the normal foot, and that medial displacement calcaneal osteotomy can reduce this increased force back toward the value occurring in the normal foot. This study provides a biomechanical rationale for medial displacement calcaneal osteotomy treatments for Posterior Tibial Tendon dysfunction.

James A. Nunley - One of the best experts on this subject based on the ideXlab platform.

  • Acquired flatfoot deformity following Posterior Tibial Tendon transfer for peroneal nerve injury : a case report.
    Journal of Bone and Joint Surgery American Volume, 2002
    Co-Authors: Christopher J. Vertullo, James A. Nunley
    Abstract:

    Anterior transfer of the Posterior Tibial Tendon is a well-recognized surgical procedure that is used to restore active ankle dorsiflexion that has been lost secondary to peroneal nerve deficiency1,2. The many causes of peroneal nerve deficiency include knee or hip trauma, surgical misadventure, tumor, and mononeuropathy3,4. The Tibialis Posterior muscle is the primary dynamic stabilizer of the medial longitudinal arch of the foot and is the primary initiator of hindfoot inversion5,6. Normal toe-off during gait requires hindfoot inversion to lock the transverse tarsal joints and hence transform the supple foot into a rigid lever arm for push-off. The normal antagonist muscle to the Tibialis Posterior is the peroneus brevis, which everts the hindfoot. Theoretically, patients who have undergone Posterior Tibial Tendon transfer should be at greater risk for the development of a flatfoot deformity secondary to the absence of function of the Posterior Tibialis muscle because of the increased stresses that are placed on the static soft-tissue supports on the medial side of the hindfoot. The plantar calcaneonavicular (spring) ligament complex appears to be the most important of these static medial soft-tissue supports. Interestingly, we are aware of no reported cases of acquired adult flatfoot deformity following transfer of the Posterior Tibial Tendon for the correction of a peroneal nerve palsy. Some authors have speculated that this lack of flatfoot development is due to the absence of active eversion of the hindfoot because the peroneus brevis is paralytic3, but others have disagreed7. We report the case of a patient in whom a symptomatic flatfoot deformity developed after an anterior transfer of the Posterior Tibial Tendon and the flexor hallucis longus Tendon was performed to restore active dorsiflexion following a peroneal nerve injury. A forty-six-year-old …