Abstract
This article provides an overview of the classification of progressive collapsing foot deformity (PCFD), along with a mnemonic aid for memorization. It also outlines the classification of spring ligament insufficiency, the surgical procedure selection process for stage 1 PCFD, and a detailed summary of surgical techniques, including key tips and potential pitfalls.
The surgical overview covers the following: patient positioning, evaluation of spring ligament insufficiency and procedure selection using tendoscopy, assessment and management timing of gastrocnemius–Achilles tendon contracture, preparation of the calcaneocuboid joint, and medial exposure for flexor digitorum longus tendon (FDLT) transfer. Two novel techniques developed by the author are introduced: corrective repair of the spring ligament (CORRS), a repair method addressing forefoot varus associated with spring ligament damage; and spring ligament reconstruction by remnant posterior tibial tendon (PTT) preservation (SREPP), a reconstruction technique that uses remnant PTT tissue to treat extensive spring ligament ruptures and concurrently correct forefoot varus. The article also offers surgical tips for FDLT transfer, bone grafting, and lateral column lengthening (LCL) via calcaneocuboid distraction arthrodesis (CCDA), with special attention to avoid residual forefoot varus.
Correction of midfoot and forefoot varus is emphasized as a crucial element in performing LCL for stage 1 PCFD. CORRS and SREPP are presented as effective adjunctive techniques that enhance the outcomes of CCDA by preventing over-lengthening and residual forefoot varus.
Figure 3Step-by-Step Procedure of CORRS.The left column shows the intraoperative progression (a–e), and the right column presents corresponding enlarged views for clarity.a. A partial tear of the spring ligament is identified at its navicular attachment site.b. The navicular side of the spring ligament is refreshed to enhance healing potential.c. The forefoot is adducted and pronated to bring the two ends of the spring ligament into contact.d. Three corresponding points are marked with a pen on the ligament and the medial margin of the navicular, followed by insertion of suture anchors.e. With the forefoot maintained in a pronated position (arrow), the marked points (red stars) are aligned and plication of the spring ligament is performed, reestablishing medial arch integrity.Reprinted with permission from NIKI.
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