Surgical Treatment of Grade III Posterior Tibial Tendon Insufficiency: Single and Double Arthrodesis

Grade III posterior tibial tendon insufficiency is a debilitating condition. When conservative measures are unsuccessful, the goal of surgical treatment of is to establish a stable, plantigrade foot and to minimize pain. The gold standard is the triple arthrodesis. However, in selected patients, limited arthrodesis, that is, isolated talonavicular arthrodesis or talonavicular arthrodesis, combined with calcaneocuboid arthrodesis may be considered. The subtalar joint may be preserved in the absence of degenerative changes and significant deformity of the hindfoot. Limited arthrodesis is indicated in cases of rigid or painful acquired flatfoot deformity in which pain and degenerative changes are limited to the transverse tarsal joints. The patient's lifestyle, physical demands, and degree of deformity must be considered in individualizing treatment.