An adult with painful flexible flatfoot fails 6 months of conservative treatment. MRI reveals a Grade III tear of the tibialis posterior tendon with peritendinous fluid and complete loss of longitudinal arch. The most appropriate surgical option is:

• A Tibialis posterior tendon repair and synovectomy alone
• B Triple arthrodesis as first-line surgical treatment
• C Medialising calcaneal osteotomy with FDL tendon transfer and possible lateral column lengthening ✓
• D Gastrocnemius lengthening alone

Explanation

Adult acquired flatfoot deformity Stage II (flexible, Grade II–III tibialis posterior dysfunction) is treated by tendon reconstruction (FDL transfer to navicular replacing the deficient tibialis posterior), combined with bony correction — medialising calcaneal osteotomy corrects hindfoot valgus and Evans calcaneal lengthening osteotomy corrects forefoot abduction. Triple arthrodesis is reserved for rigid Stage III–IV deformity. Repair alone fails because the tendon is too degenerate.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.