| Objective:To increase the treatment effect by bringing forward the operationopportunity and improve the method of insertion reconstruction in posteriortibial tendon transposition.Method:We selected9cases, namely13feet in our department since2009,including8boys and1girl. Their medical histories lasted from5months to3years, average12months. All of them were rigid type and got poor effect afterthe conservative treatment. Soft tissue release (cutting off plantar fascia andachilles tendon lengthening) and posterior tibial tendon transpositionreconstructing dorsiflexion function of ankle were used in our surgeries. We cutoff the peroneus brevis tendon at the joint of tendon and venter musculi abovelateral malleolus and the9-cm-long distal end of tendon was conserved.We leadthe distal end of peroneus brevis tendon to the inner side of the third metatarsalbone, the lower side and the outer side between metatarsal bones and extensortendon.Then we draw the distal end of tendon out from the outer side of thethird metatarsal bone and reconstructed the insertion of the peroneus brevistendon at15°when ankle dorsiflexion. The posterior tibial tendon and peroneusbrevis tendon were braided under a suitable tension in order to correct theadduction, internal rotation and plantar flexion deformity. To correct the varusdeformity of heel,1.2mm K-wire was used to fix the calcaneus,talus to tibia.After6weeks’ fixation of plaster cast, the K-wire could be removed.Bothcorrective shoe and arch stimulus were used in exercise.Results: We followed up all cases for12months to36months, average18months.Garceau standard was used to estimate the effect. Excellent:normalappearance, stable joint, no adduction deformity, normal gait. Good:mostdeformity is corrected, ankle and gait is good, mild adduction or varusdeformity. Moderate:significantly improvement, gait is good, mild internalrotation and plantar flexion deformity. Bad:little improvement, obvious limp,limited walking. In our study, there were10excellent cases and3good cases.Conclusion:1.Surgeries should be conducted before3years old in those severe casesthat can’t get good effect by conservative treatment. The development of nervefunction is not completed and excellent plasticity is good for the functiontransition of tendon. About exercise, arch stimulus can promote tendonmovement and function recovery.2.The method of leading the peroneus brevis tendon around the thirdmetatarsal bone and reconstruct the insertion of posterior tibial tendon solvedthe difficult problem of shortage and rupture of posterior tibial tendon. Braidedsuture can sustain much more tension, so early exercise is possible. Theinsertion of peroneus brevis tendon is near the lateral side of foot. It canstrengthen eversion and correct adduction and varus deformity. |
