Medial displacement calcaneal osteotomy with flexor digitorum longus transfer is a common treatment for the management of the adult flatfoot associated with posterior tibial tendon dysfunction. In the literature, there is a paucity of information regarding the ability of patients to return to sport and recreational activities after this surgical procedure. The purpose of this retrospective clinical study was to assess the rate and type of athletic activities that patients participated in before and after medial displacement calcaneal osteotomy with flexor digitorum longus transfer.
A consecutive series of 42 patients with a mean age at surgery of 41 years (range 19–74 years) was evaluated with a minimum follow-up of 24 months (range 18–31 months). Pre- and post-operative sporting activities were assessed. At final follow-up, patients were asked to complete a Sports Athlete Foot and Ankle Score (SAFAS). Each patient was also evaluated with weight-bearing radiographs of the foot before surgery and at final follow-up.
Preoperatively, 27 of 42 (64.3 %) patients were engaged in athletic activities, participating in an average of 1.4 h/week (range 0–6 h/week); post-operatively, 36/42 (85.7 %) participated in sport and recreational activities for an average of 3.5 h/week (range 0–15 h/week). Meary’s angle improved significantly from 11.5 ± 6.2 degrees preoperatively to 7.0 ± 5.7 degrees at final follow-up (p < 0.01); calcaneal pitch improved significantly from 16.5 ± 4.6 degrees to 19.0 ± 5.0 degrees (p < 0.01). At final follow-up, patients demonstrated good SAFASs in symptom tolerance (86.4 %), pain tolerance (89.0 %), daily living performance (96.1 %), and sports performance (86.7 %).
The majority of patients returned to sports and recreational activity after medial displacement calcaneal osteotomy and flexor digitorum longus for the treatment of adult flatfoot associated with posterior tibial tendon dysfunction.
Level of evidence
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Medial displacement calcaneal osteotomy
Flexor digitorum longus
American Orthopaedic Foot and Ankle Society
Sports Athlete Foot and Ankle Score
Body mass index
Magnetic resonance imaging
Coster M, Rosengren B, Bremander A, Karlsson M (2015) Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain, improves function and health related quality of life. Foot Ankle Surg. 21(4):286–289
Wacker JT, Hennessy MS, Saxby TS (2002) Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of tibialis posterior. Three- to five-year results. J Bone Joint Surg Br 84(1):54–58
Yao K, Yang TX, Yew WP (2005) Posterior tibialis tendon dysfunction: overview of evaluation and management. Orthopedics. 38(6):385–391
Bluman EM, Title CI, Myerson MS (2007) Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 12(2):233–249
Myerson MS, Badekas A, Schon LC (2004) Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int 25(7):445–505
Guyton GP (2016) Minimally invasive osteotomies of the calcaneus. Foot Ankle Clin. 21(3):551–566
Kheir E, Borse V, Sharpe J, Lavalette D, Farndon M (2015) Medial displacement calcaneal osteotomy using minimally invasive technique. Foot Ankle Int 36(3):248–252
Chadwick C, Saxby T (2015) Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction. Bone Joint J. 97-B(3):346–352
Guha AR, Perera AM (2012) Calcaneal osteotomy in the treatment of adult acquired flatfoot deformity. Foot Ankle Clin. 17(2):247–258
Guyton GP, Jeng C, Krieger LE, Mann RA (2001) Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for posterior tibial tendon dysfunction: a middle-term clinical follow-up. Foot Ankle Int 22(8):627–632
Marks RM, Long JT, Ness ME, Khazzam M, Harris GF (2009) Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy. Gait Posture. 29(1):17–22
Niki H, Hirano T, Okada H, Beppu M (2012) Outcome of medial displacement calcaneal osteotomy for correction of adult-acquired flatfoot. Foot Ankle Int 33(11):940–946
Schuh R, Gruber F, Wanivenhauus A, Hartig N, Windhager R, Trnka HJ (2013) Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematics and functional results of fifty one feet. Int Orthop 37(9):1815–1820
Talusan PG, Cata E, Tan EW, Parks BG, Guyton GP (2015) Safe zone for neural structures in medial displacement calcaneal osteotomy: a cadaveric and radiographic investigation. Foot Ankle Int 36(12):1493–1498
Charwat-Pessler CG, Hofstaetter SG, Jakubek DE, Trieb K (2015) Interference screw for fixation of FDL transfer in the treatment of adult acquired flat foot deformity stage II. Arch Orthop Trauma Surg 135(10):1369–1378
Maffulli N, Chan KM, Macdonald R, Malina RM, Parker AW (eds) (2001) Sports medicine for specific ages and abilities. Church Livingstone, London, pp 307–314
Espinosa N, Maurer MA (2015) Stage I and II posterior tibial tendon dysfunction: return to running? Clin Sports Med 34(4):761–768
Toullec E (2015) Adult flatfoot. Orthop Traumatol Surg Res. 101(1):S11–S17
Morssinkhof ML, Wang O, James L, van der Heide HJL, Winson IG (2013) Development and validation of the sports athlete foot and ankle score: an instrument for sport-related ankle injuries. Foot Ankle Surg. 19(3):162–167
Sokal RR, Rohlf FJ (1995) Biometry. The principles and practice of statistics in biological research, 3rd edn. Freeman, New York: 184–190, 223–227
Conflict of interest
The author declare that they have no conflict of interest related to this study.
All procedures performed in studies involving human participants were in acordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Usuelli, F.G., Di Silvestri, C.A., D’Ambrosi, R. et al. Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer. Knee Surg Sports Traumatol Arthrosc 26, 892–896 (2018). https://doi.org/10.1007/s00167-016-4360-2
- Posterior tibialis tendon dysfunction
- Medial displacement calcaneal osteotomy
- Tendon transfer
- Return to sport
- Meary angle
- Calcaneal pitch