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Hindfoot Fusions in the Flatfoot Deformity: When and What Techniques to Use in Late Stage II and Stage III Deformities

Seybold, Jeffrey D. MD; Zide, Jacob R. MD; Myerson, Mark S. MD

Techniques in Foot & Ankle Surgery: March 2014 - Volume 13 - Issue 1 - p 29–38
doi: 10.1097/BTF.0000000000000034
Special Focus: Surgical Treatment of Symptomatic Flatfoot Deformity

Classically, the patient presenting with a stage II posterior tibial tendon rupture is distinguished from the stage III patient by the presence of hindfoot stiffness. As with all deformities, there are certainly shades of gray between the 2 stages and a “one-size-fits-all” approach is inappropriate. Typically, the more longstanding the deformity, the greater the likelihood of progression of arthritis and hindfoot rigidity, but this is not always the case. Some patients may have only partial loss of hindfoot motion and the surgeon may be tempted to “push the limits” for joint-sparing procedures, or conversely, to perform a triple arthrodesis in a patient who does not have a completely rigid deformity. In the following pages we will discuss the evaluation of the “late” stage II and stage III posterior tibial tendon rupture and present a variety of arthrodesis techniques that successfully address these conditions.

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Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD

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The authors declare no conflict of interest.

Address correspondence and reprint requests to Mark S. Myerson, MD, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202. E-mail:

© 2014 by Lippincott Williams & Wilkins