Point-Counterpoint: Is The Flexor Digitorum Longus Tendon Transfer Effective For Stage 2 Adult-Acquired Flatfoot?

William T. DeCarbo, DPM, AACFAS; Lawrence A. DiDomenico, DPM, FACFAS, Ramy Fahim, DPM, AACFAS, and Zachary Thomas, DPM

   Many outcome studies exist on the flexor digitorum longus tendon transfer for Stage 2 PTTD. Most recently, Kou and coworkers published a prospective study of 24 patients who underwent a flexor digitorum longus tendon transfer to the navicular, a double calcaneal osteotomy and gastrocnemius recession.23 Twenty-three patients were available for a two-year follow-up. All patients had statistical improvement in the Visual Analog Scale, the Foot And Ankle Outcome Survey, the Assessment of Daily Living, the Rowan Foot Pain Assessment Questionnaire and SF-12 scores at one year postoperatively with maintenance of the improvement at two years with good functional results.

In Conclusion

Despite the relative lack of strength of the flexor digitorum longus tendon in comparison to the posterior tibial tendon, there are multiple advantages to transferring this tendon to augment the posterior tibial tendon. The flexor digitorum longus tendon originates adjacent to the posterior tibial tendon and runs with it to its distal insertion. This allows for the posterior tibial tendon repair or resection and the flexor digitorum longus tendon transfer through the same incision. The flexor digitorum longus tendon also does not cross the posterior tibial neurovascular bundle, thus avoiding any potential impingement. The flexor digitorum longus tendon fires in the same phase of the gait cycle of the posterior tibial tendon.

   The flexor digitorum longus transfer with subsequent gastrocnemius recession and calcaneal osteotomy offer patients a predictable outcome that increases function and eliminates pain.

   Dr. DeCarbo is a fellowship trained foot and ankle surgeon. He is in private practice with The Orthopedic Group in Pittsburgh. Dr. DeCarbo is board-qualified in foot, reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery, and is an Associate of the American College of Foot and Ankle Surgeons.

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