Cobb procedure and Rose calcaneal osteotomy for the treatment of tibialis posterior tendon dysfunction

Forty-three patients with stage 2 posterior tibialis tendon dysfunction underwent surgical reconstruction in the form of a Cobb procedure and Rose calcaneal osteotomy between 1997 and 2003, and were evaluated pre- and postoperatively. The average age was 57 years, and the mean followup time was 51 months (range 10-83). The average AOFAS score preoperatively was 58 and improved to 85 postoperatively (p < 0.0001). Sixty-six per cent of patients achieved a single heel raise. Eighty-four per cent expressed a subjective satisfaction rate, whilst 16% reported no improvement. Seventy-eight per cent of the patients were able to use normal shoes and 65% no longer required the use of any orthotics. The minor complication rate was 16% with no major complications. All osteotomies united uneventfully. Two patients have subsequently developed subtalar osteoarthritis, and six calcaneal screws had to be removed for prominence and tenderness. Our results compare very favourably with other less anatomical reconstructions, any donor site morbidity has been avoided and there have been very low complication rates.