Posterior tibial tendon dysfunction: tendon transfers, osteotomies, and lateral column lengthening

The recognition of Posterior Tibial Tendon Dysfunction (PTTD) as a cause of adult acquired flatfoot has spurred significant evolution of its treatment during the past twenty years. Renewed interest in its pathophysiology and treatment options has led to the creation of several new regimens. Because the treatment of PTTD is relatively new, many of these surgical protocols have relative short-term follow up, hence the controversy regarding the ideal surgical technique for its treatment. This review discusses the current concepts regarding the pathology, diagnosis, and treatment options for this disease. In particular the treatment of Stage 2 PTTD will be discussed.