Abstract
We investigated the outcome of surgical treatment for adult acquired flatfoot caused by posterior tibialis tendon dysfunction (PTTD) treated by calcaneocuboid distraction arthrodesis (CDDA).
Between 2001 and 2003 we performed CDDA on 9 feet (PTTD stage 2) of 9 patients (1 man and 8 women, average age 53 years; range 48-56 years). The average follow-up period was 19 months (range 8-32 months).
Surgery was performed under spinal anesthesia. The calcaneocuboid joint was distracted 1 cm with a lamina spreader while a tricortical iliac crest bone graft was inserted into the joint. One graft had no internal fixation of the grafted bone, 1 graft was fixed with two crossed Kirschner wires, and 7 grafts were fixed with a cortical screw. The average AOFAS score improved from 58.6 before operation to 81.7 at the most recent follow-up. Plain radiography showed improvement of the arch of the foot. In 2 cases, one without internal fixation and one fixed with Kirschner wire, the grafted bone collapsed in 8 weeks and 12 weeks after surgery, respectively. Both of the patients underwent re-operation to fix the bone graft fixed with a cortical screw. At the most recent follow-up, bone union had occurred in all cases. CCDA with rigid fixation of the grafted bone was effective for the treatment of stage 2 in these cases of PTTD.
