Progressive Collapsing Foot Deformity. Is There Really a Johnson and Strom Stage I?

Area of Science:

• Orthopedics
• Sports Medicine
• Podiatry

Background:

• Posterior tibialis tendon dysfunction (PTTD) is a common cause of medial foot pain.
• Stage I PTTD is characterized by pain and swelling without significant deformity or functional loss.
• Etiologies include tendinopathy due to overuse, biomechanical factors like gastrocnemius tightness, or systemic inflammatory conditions.

Purpose of the Study:

• To outline the clinical presentation, diagnosis, and management of Stage I posterior tibialis tendon dysfunction.
• To discuss the pathomechanics and contributing factors for Stage I PTTD.
• To review current and potential treatment strategies for Stage I PTTD.

Main Methods:

• Clinical diagnosis based on patient history and physical examination.
• Review of pathomechanics, including tendinous overloading and contributing factors.
• Evaluation of conservative and surgical treatment options for Stage I PTTD.

Main Results:

• Diagnosis of Stage I PTTD is primarily clinical.
• Medial heel wedged orthoses demonstrate effectiveness in managing symptoms for most patients.
• Surgical interventions include tenosynovectomy (open or endoscopic) for persistent symptoms or tendon rupture, with flexor digitorum longus tendon transfer as an option for complete rupture.
• Prophylactic medializing calcaneal osteotomy may benefit high-risk patients (inflammatory conditions, laxity, obesity) to prevent progression.

Conclusions:

• Stage I PTTD requires a clinical diagnosis and understanding of underlying pathomechanics.
• Conservative management with orthoses is often effective, but surgical options exist for specific indications.
• Risk stratification is important, with prophylactic surgery considered for individuals at higher risk of disease progression.