Indian Journal of Orthopaedics

, Volume 54, Issue 1, pp 22–30 | Cite as

Surgical Management of Symptomatic Adult Pes Planovalgus Secondary to Stage 2B Posterior Tibial Tendon Dysfunction: A Comparison of Two Different Surgical Treatments

  • Christopher Fang Junxian
  • Remesh Kunnasegaran
  • Gowreeson ThevendranEmail author
Original Article



This study compares radiological and functional outcomes of patients with symptomatic Adult Acquired Flat Foot Deformity (AFFD) secondary to stage 2B Posterior Tibial Tendon Dysfunction (PTTD) treated with either a Subtalar Arthroereisis (SA) implant or a Lateral Column Lengthening (LCL) procedure. The aim of the study is to determine if the Subtalar Arthroereisis procedure is an acceptable surgical adjunct in our treatment armamentarium.

Materials and Methods

21 patients (22 feet) were evaluated. 12 consecutive patients (n = 12) underwent a Subtalar Arthroereisis procedure while 9 patients (n = 10) underwent a Lateral Column Lengthening procedure. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Score (AOFAS) midfoot score, Short Form 36 (SF-36) and Visual Analog of Pain Scale (VAS), preoperatively and at 6 and 12 months postoperatively. 10 radiological parameters were analyzed. All complications were tabulated.


Significant improvements in functional outcomes were noted in both groups of patients. Radiographically, some loss of correction was noted in the SA group and no loss of correction in the LCL group, respectively. In the SA group, 6 patients complained of sinus tarsi pain in the postoperative period and 4 required removal of implants. No implants were removed in the LCL group.


The results suggest that subtalar arthroereisis may be a reasonable procedure to utilize in the treatment of AAFD, albeit with a relatively high implant-removal rate.


Pes planovalgus Flatfeet Subtalar arthroereisis Lateral column lengthening 


Author contributions

The collection and analysis of the data, as well as writing the manuscript were prepared by both the first and second authors of this paper. We thank senior author Mr. Gowreeson Thevendran for his invauable counsel and guidance without which this manuscript would not have been written.

Compliance with Ethical Standards

Conflict of interest

All three authors of this original manuscript declare that we do not have any conflicts of interest in the publishing of this paper.

Ethical standard statement

No human or animal subjects were utilized as part of this study. We firmly believe and attest to the ethical standards of the paper.

Informed consent

Informed consent was not required for the publishing of this paper as the data collected was anonymous and not retrospectively identifiable.


No support in the form of grants, equipment, drugs, or any other form were utilized for the completion of this study. None of the authors involved in this study have any financial or other arrangements which constitute a conflict of interest. This manuscript has been read and approved by all authors of the study and will vouch for the integrity of the research conducted. This manuscript has not been submitted to any other journal for consideration and has not been previously published.


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Copyright information

© Indian Orthopaedics Association 2020

Authors and Affiliations

  • Christopher Fang Junxian
    • 1
  • Remesh Kunnasegaran
    • 1
  • Gowreeson Thevendran
    • 1
    • 2
    Email author
  1. 1.Department of Orthopaedic SurgeryTan Tock Seng HospitalSingaporeSingapore
  2. 2.Mount Elizabeth Medical Centre, Mount Elizabeth Hospital SingaporeSingaporeSingapore

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