Arthrodesis techniques in the management of stage II and III acquired adult flatfoot deformity.

The proper management of acquired flatfoot deformity requires obtaining a careful patient history and physical examination of the foot, ankle, and lower extremity. Accurate assessment of foot flexibility and localization of pain will aid in decision making. Nonsurgical management may not be successful in patients with advanced disease, particularly with the development of degenerative changes. Surgical management of advanced acquired adult flatfoot deformity (stages III and IV) is indicated with failure of nonsurgical management and consists primarily of arthrodesis for the foot component of the deformity. The foot component may include the subtalar, talonavicular, calcaneocuboid, or tibiotalar joints, or a combination of these joints. Adjunctive procedures, such as Achilles tendon lengthening, medial displacement calcaneal osteotomy, lateral column lengthening, and plantar flexion osteotomy of the first ray are useful in correcting residual deformities after hindfoot realignment. Proper selection of surgical procedures will maximize the potential for a good outcome. It is critical to correct all components of the deformity simultaneously in order to minimize recurrence of the deformity.