Lateral Column Lengthening in the Adult Acquired Flatfoot

The surgical treatment of posterior tibial tendon insufficiency, or adult acquired flatfoot deformity, is a topic of great debate and can encompass many forms. This paper focuses on the treatment of stage 2 posterior tibial tendon insufficiency (a flexible flatfoot deformity) utilizing simultaneous correction of bony and soft tissue abnormalities in the forefoot, midfoot, and/or hindfoot. The principles of reconstruction involve correcting hindfoot valgus deformity with a lateral column lengthening procedure or a medializing calcaneal osteotomy, correcting midfoot or forefoot varus with a medial column stabilization through arthrodesis of the first tarsometatarsal or naviculocuneiform joint, reconstruction of the posterior tibial tendon with a flexor digitorum longus tendon transfer, and correction of equinus deformity by gastrocnemius or tendo-Achilles lengthening. The rationale for treatment and details of operative management are discussed.