Related Experiment Video
Updated: Jul 14, 2026
04:03
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Stage IV posterior tibial tendon rupture
Eric M Bluman1, Mark S Myerson
1Division of Orthopaedics, Orthopaedic Foot and Ankle Service, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA. emb43@cornell.edu
Foot and Ankle Clinics
|June 15, 2007
Summary
Adult acquired flatfoot deformity has four stages, with the fourth involving the tibiotalar joint. Treatment for this advanced stage depends on whether the deformity is rigid or supple.
Area of Science:
- Orthopedics
- Podiatry
- Foot and Ankle Surgery
Background:
- Adult acquired flatfoot deformity (AAFD) progresses through distinct stages.
- The Myerson modification added a fourth stage, indicating tibiotalar joint involvement.
- This advanced stage features hindfoot valgus and talar valgus within the mortise.
Purpose of the Study:
- To describe the characteristics of the fourth stage of AAFD.
- To outline treatment strategies for this advanced stage based on joint rigidity.
Main Methods:
- Review of the modified Johnson and Strom classification system.
- Analysis of AAFD progression and its impact on the tibiotalar joint.
- Correlation of deformity rigidity with surgical treatment options.
Main Results:
- The fourth stage of AAFD involves hindfoot malalignment and tibiotalar joint degeneration.
- Deformity can be rigid or supple.
- Rigid deformities necessitate ankle and hindfoot fusions.
- Supple deformities may be managed with joint-sparing reconstructive procedures.
Conclusions:
- The Myerson modification provides a comprehensive classification for advanced AAFD.
- Treatment for stage IV AAFD should be tailored to the rigidity of the tibiotalar joint.
- Joint-sparing procedures offer an alternative for supple deformities.
