Outcomes for surgical correction for stages 2 and 3 tibialis posterior dysfunction

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction
• Biomechanical Engineering

Background:

• Tibialis posterior dysfunction involves progressive flatfoot deformity.
• Mueller's classification stages tibialis posterior dysfunction from 2 (tendinitis) to 3 (forefoot abductus).
• Conservative treatment precedes surgical intervention for these stages.

Purpose of the Study:

• Evaluate surgical outcomes for stage 2 and stage 3 tibialis posterior dysfunction.
• Compare patient satisfaction and pain reduction between different surgical approaches.
• Assess the effectiveness of Cobb and Cobb-Evans procedures.

Main Methods:

• Retrospective evaluation of 13 patients (1991-1996) with stage 2 or 3 dysfunction.
• Stage 2: Cobb reconstruction with split tibialis anterior tenodesis.
• Stage 3: Evans lateral column lengthening plus Cobb procedure.
• Follow-up: 12-63 months, including radiographic assessment and patient interviews.

Main Results:

• Stage 2 patients reported better satisfaction than stage 3 patients.
• Both groups experienced a 6-point average pain decrease (visual analog scale).
• 50% of stage 3 patients felt the Cobb-Evans procedure did not meet expectations; only 1 stage 2 patient felt this way.

Conclusions:

• Cobb reconstruction alone yielded higher patient satisfaction for stage 2 dysfunction.
• While Cobb-Evans surgery corrects stage 3 deformities radiographically, it may lead to persistent lateral column pain and dissatisfaction.
• Further hindfoot procedures like osteotomies or arthrodesis might improve outcomes for severe cases.