Adult flatfoot/posterior tibial tendon dysfunction: outcomes analysis of surgical treatment utilizing an algorithmic approach.

A new classification scheme is presented along with an algorithmic surgical approach to the treatment of posterior tibial tendon dysfunction (PTTD). This classification scheme treats as separate entities the soft-tissue and osseous components of PTTD. The soft-tissue pathology is staged from tendinitis to tendinosis to that of complete rupture. The osseous element is graded as no planar deformity, reducible planar deformity, or rigid planar deformity. The stage of soft-tissue pathology is then combined with the grade of the osseous condition, leading to a comprehensive surgical treatment plan. Based on this classification, 13 patients were retrospectively evaluated. Only those patients falling into a specific classification (2A and 2B) were included in this analysis. The American Orthopedic Foot and Ankle Society clinical hindfoot-ankle scale was utilized. The mean preoperative clinical rating was 32.8. The mean postoperative clinical rating was 88.0. Pre- and postoperative radiographic criteria were also analyzed. Overall patient satisfaction utilizing this treatment algorithm was good to excellent.