Novel technique for deltoid spring complex reconstruction in progressive collapsing foot disorder

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Biomechanical engineering

Background:

• Adult Acquired Flatfoot Deformity (AAFD) involves progressive medial arch collapse and instability, often due to posterior tibial tendon dysfunction.
• Stage II flexible AAFD presents with peritalar subluxation, necessitating surgical intervention when conservative methods fail.
• The deltoid and spring ligament complex is crucial for foot stability, and its reconstruction is key in AAFD treatment.

Purpose of the Study:

• To compare the efficacy of two novel surgical techniques, Quadrangular and Triangular repairs, for reconstructing the deltoid spring complex in Stage II AAFD.
• To evaluate the combined effect of these novel repairs with medial displacement calcaneal osteotomy (MCDO) on foot biomechanics and alignment.
• To assess functional and radiological outcomes of these techniques in patients with Adult Acquired Flatfoot Deformity.

Main Methods:

• A prospective study involving 40 patients with Stage II AAFD, unresponsive to conservative treatment.
• Surgical intervention included either Quadrangular or Triangular repair using fiber tape or wire, combined with MCDO.
• Clinical assessments (AOFAS scale) and radiological evaluations (Meary's angle, talonavicular coverage, tibial-calcaneal angle) were performed preoperatively and at 3 and 12 months post-surgery.

Main Results:

• Both Quadrangular and Triangular repair techniques, combined with MCDO, demonstrated significant improvements in AOFAS scores and radiological parameters at 3 and 12 months.
• Triangular repair showed a slight advantage in functional outcomes, while both techniques effectively restored foot biomechanics and alignment.
• Minor complications such as wound dehiscence and persistent pain were reported but resolved with conservative management.

Conclusions:

• Quadrangular and Triangular repair techniques, augmented with fiber tape or wire and MCDO, are effective surgical options for Stage II AAFD.
• Both methods yield significant clinical and radiological improvements, with Quadrangular repair potentially offering better functional recovery in severe cases.
• Personalized treatment selection based on talonavicular coverage may optimize outcomes for patients with Adult Acquired Flatfoot Deformity.