International Orthopaedics

, Volume 37, Issue 9, pp 1815–1820 | Cite as

Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematic and functional results of fifty one feet

  • Reinhard SchuhEmail author
  • Florian Gruber
  • Axel Wanivenhaus
  • Nikolaus Hartig
  • Reinhard Windhager
  • Hans-Joerg Trnka
Original Paper



Stage II posterior tibial tendon dysfunction (PTTD) can be treated by flexor digitorum longus (FDL) tendon transfer and medial displacement calcaneal osteotomy (MDCO). Numerous authors have studied the clinical and radiographic results of this procedure. However, little is known about the kinematic changes. Therefore, the purpose of this study was to assess plantar-pressure distribution in these patients.


Seventy-three patients with PTTD stage II underwent FDL tendon transfer and MDCO. Plantar pressure distribution and American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed 48 months after surgery. Pedobarographic parameters included lateral and medial force index of the gait line, peak pressure (PP), maximum force (MF), contact area (CA), contact time (CT) and force-time integral (FTI).


In the lesser-toe region, PP, MF, CT, FTI and CA were reduced and MF in the forefoot region was increased. These changes were statistically significant. We found statistically significant correlations between AOFAS score and loading parameters of the medial midfoot.


Study results reveal that FDL tendon transfer and MDCO leads to impaired function of the lesser toes during the stance phase. However, there seems to be a compensating increased load in the forefoot region.


Stage II posterior tibial tendon dysfunction FDL transfer and calcaneal osteotomy Kinematic and functional results 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Reinhard Schuh
    • 1
    Email author
  • Florian Gruber
    • 2
  • Axel Wanivenhaus
    • 1
  • Nikolaus Hartig
    • 3
  • Reinhard Windhager
    • 1
  • Hans-Joerg Trnka
    • 3
  1. 1.Department of OrthopaedicsMedical University of ViennaViennaAustria
  2. 2.Department of Orthopaedic SurgeryHerz Jesu KrankenhausViennaAustria
  3. 3.Foot and Ankle CenterViennaAustria

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