Posterior Tibial Tendon Insufficiency

Question 1

What is the major antagonist to the posterior tibial tendon?

Answer 1

Peroneus brevis

Question 2

What are the stages of posterior tibial tendon insufficiency?

Answer 2

Stage 1: tenosynovitis; can perform single leg rise; no deformity
Stage 2A: flatfoot deformity, normal forefoot, flexible hindfoot
Stage 2B: flatfoot deformity, abducted forefoot (too many toes; >40% navicular uncovered)
Stage 3: Rigid hindfoot valgus and rigid forefoot
Stage 4: Stage 3 with deltoid compromise (will talar tilt)

Question 3

What are non-operative treatments for PTTI?

Answer 3

Medial heel lift, AFO

Question 4

What are the surgical options for stage 2 PTTI?

Answer 4

FDL transfer, calcaneal osteotomy, +/- lateral column lengthening (if >40% uncovering; 2B), forefoot correction for varus with Cotton osteotomy

Question 5

What are the surgical options for stage 3 PTTI?

Answer 5

Triple arthrodesis and TAL

Question 6

What are the surgical options for stage 4 PTTI?

Answer 6

Triple arthrodesis if correctible hindfoot

Tibiocalcaneal arthrodesis if rigid hindfoot