A 45-year-old woman with rheumatoid arthritis presents with painful planovalgus (flatfoot) deformity that is flexible on single-heel-rise test. MRI reveals complete rupture of the tibialis posterior tendon. The most appropriate surgical option is:
- A Tibialis posterior tendon repair alone
- B Triple arthrodesis
- C Subtalar arthrodesis alone
- D Flexor digitorum longus (FDL) tendon transfer with medializing calcaneal osteotomy ✓
Explanation
Tibialis posterior tendon dysfunction (TPDT) Stage II is flexible flatfoot with tendon rupture; the single-heel-rise test fails. FDL transfer (Johnson-Strom procedure) restores the invertor mechanism; it is augmented with a medializing calcaneal osteotomy (Evans or Koutsogiannis) to correct the valgus hindfoot and redistribute load. Direct repair is not possible with a ruptured tendon. Triple arthrodesis (subtalar + talonavicular + calcaneocuboid) is reserved for Stage III/IV (rigid deformity with arthritic changes) and sacrifices significant hindfoot motion. Subtalar arthrodesis alone does not address the midfoot abduction.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.