When Conservative Treatment Fails For Posterior Tibial Tendon Dysfunction

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Jesse Burks, DPM, FACFAS

In the end, despite the patient's obesity and non-adherence, she healed exceptionally well and does not require the use of any type of brace. She does still use a custom orthotic regularly.

   Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice in Little Rock, Ark. Dr. Burks has disclosed that he is a consultant for Extremity Medical.

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Zoltan Koos MD FRCSsays: January 21, 2014 at 2:20 pm

I am glad to hear that the isolated talonavicular fusion with medialising calcaneal osteotomy did work in the reported patient. I did this combination for one of my patients with grade 3 tibialis posterior dysfunction two years ago. I had the same dilemma to choose between the triple fusion and the isolated one, and I really did not want to do the triple one for that patient.

The little difference from the above described procedure was that I had to do a percutaneous Achillotomy as well at the beginning in order to bring the heel back from the equinus. He was 79 years old but extremely active to his age. I had the same fear that he would not be able to cope with six weeks of non-weightbearing so I used a dorsal locking plate plus a compression screw for the TN fusion.

Well, he did put his weight on the operated foot as early as the second postoperative day in spite of the clear instructions. I kept him in a scotch cast and later in an air walker boot for a combined 12 weeks. His recovery was unexpectedly remarkable. When he came for the six months post-op consultation, he said that the weekend before he played 18 holes on the golf court with no pain. At his 12 month follow-up, he reported some occasional ache laterally but generally he was quite pleased with the outcome.

I think we should have this combined procedure in mind as an alternative to a triple fusion.

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