New Surgery Improves Flat Foot Outcomes
Interesting article about improving outcomes in patients with severe adult flat foot deformity
Interesting modification (eg. to add reconstruction of the deltoid ligament in the operative management of advanced flatfoot deformities).
Evidence based medicine would, however, require a comparative study, in order to draw definite conclusions.
Furthermore, I would ask: Do all these patients require this additional procedure that -potentially- sacrifices peroneus longus?
Was the deltoid ligament always deficient?
In my view, if tibialis posterior is reconstructed using FDL (tendon transfer), dissecting distally to the knot of Henry to obtain enough length, to allow strong tightening of FDL into itself, (passing it through a navicular tunnel), good support of the medial arch is achieved (and no other procedure is needed).
I do agree with Dr. Gougoulias. I wonder if an investigation was performed to demostrate the insuffiiciency of Deltoid ligament preoperatively? I donot agree to sacrifice of PL for reconstruction in healthy individuals. PL has a very important role in foot mechanics.