Severe Flat Foot Correction via Triple Arthrodesis in Morbidly Obese Patient


Stage 3 PTTD patient that was referred with MRI already performed….PT tendon ruptured, and spring ligament torn.

Interestingly, the spring ligament damage is evident on lateral plain film with dorsal cortices of TN not matching up. Additionally, profound supination weakness seen on exam provides enough info to confirm PT is insufficient….X-rays and exam give you Stage 3, without necessity for MRI….. At Stage 3, coupled with morbid obesity, patient is guaranteed triple arthrodesis. Painful bunion was also consideration so we chose osteotomy rather than arthrodesis.

Due to severity of deformity and foot type – we felt addition of CC fusion allowed some mild forefoot varus to be addressed without need for opening wedge osteotomy at midtarsal articulation, or plantarflexory TMT arthrodesis.

Post op films were taken at 10 wks from date of surgery with nice unions evident.

Stage 3 patients are stiffer for sure. But seemingly some of the happiest post-operatively, as we’ve found they learned to live with bad deformity and pain longer than necessary.