Treatment concepts for pes valgoplanus with concomitant changes of the ankle joint
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Christian Plaass1 · Jan Willem Louwerens2 · Leif Claassen1 · Sarah Ettinger1 · Daiwei Yao1 · Matthias Lerch1 · Christina Stukenborg-Colsman1 · Christian Donken2 1
© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020
Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Hannover, Germany 2 Foot and Ankle Reconstruction Unit of the Orthopaedic Department, St. Maartenskliniek, Ubbergen, The Netherlands
Treatment concepts for pes valgoplanus with concomitant changes of the ankle joint Tibiotalocalcaneal arthrodesis, total ankle replacement and joint-preserving surgery
Introduction Flatfoot deformity (FD) issues are a common reason for consulting orthopedic doctors. Different kinds of flatfeet (FF) must be differentiated. There is a lack of complete understanding of the pathophysiology of acquired FD. The dominant philosophy in the literature is that dysfunction of the tibialis posterior tendon plays an important role in the aetiology and progression of flatfeet. To what extent dysfunction of the tibialis posterior tendon is the primary cause or secondarily involved, is a matter of debate. The Myerson classification (. Table 1) is generally understood as a consecutive development of the severity of FF. In this understanding stage I deformities with overload pain of the stabilizing structures, develop to a flexible deformity (stage II) due to more degenerative changes of the tendons and ligaments. Stage III resembles the fixed deformity due to a long-standing malposition of the joint and in severe cases this can lead to overload and secondary failure or degenerative changes of the ankle as stage IV. (. Fig. 1). The Myerson classification and its modification are used for practical purposes, scientific communication and education, because there is no better generally accepted alternative classification [1, 2]; however, the impor-
tance of the tibialis posterior tendon is probably overestimated. Looking more closely at the definition of stage IV deformities, this is defined as a tilting of the talus into valgus in the ankle mortise, associated with a pes valgoplanus, typically in stages II and III. Nevertheless, in contrast to the general conviction, stage IV AAFD can be associated with a flexible flatfoot. Further on, it is subclassified in stage IV-A, flexible ankle valgus, without substantial tibiotalar arthritis, and stage IV-B, rigid ankle valgus or flexible ankle valgus with significant tibiotalar arthritis. Stage IV AAFD is a rare entity, with only 2.3% of patients surgically treated for AAFD [3].
Etiology Although most stage IV AAFD develop from a stage III AAFD, neither all stage III AAFD progress to a stage IV disease nor is a fixed or severe deformity mandatory for the development of talar tilt in stage IV diseases. The pathophysiology of the development of AAFD is not yet fully understood. Dysfunction of the active stabilizing tibialis posterior tendon has been associated with the development of AAFD. In con-
Abbreviations AAFD
Adult acquired flatfoot defor
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