Tendon Transfers for Posterior Tibial Tendon Dysfunction

Abstract

Many surgical procedures have been described for treatment of the adult-acquired flatfoot owing to posterior tibial tendon dysfunction. Chief among these is tendon transfer about the hindfoot to restore motor power and prevent progressive deformity. Tendon transfer is indicated in the setting of a flexible deformity, whereas a rigid deformity requires hindfoot arthrodesis. Earlier procedures included flexor digitorum longus tenodesis and anterior tibial tendosuspension (Young's suspension). In the recent literature, flexor digitorum longus transfer has become the most widely used procedure. Results indicate that these tendon procedures typically yield good pain relief, allow resumption of most activities, and provide some restoration of motor power. However, the correction of flatfoot deformity has been incomplete with these transfers, which has prompted surgeons to investigate additional bony procedures to optimize results. With appropriate indications and careful attention to technique, good results can be achieved and complications minimized.