Radiographic Outcomes after Flexible Flatfoot Reconstruction with and without Spring Ligament Reconstruction

CATEGORY: Hindfoot INTRODUCTION/PURPOSE: The purpose of this study was to determine postoperative radiographic differences between patients who underwent flexible flatfoot reconstruction and spring ligament repair with a FiberTape suture device versus those who underwent spring ligament reconstruction with suture repair alone or those without reconstruction of the spring ligament for patients with Stage II adult acquired flatfoot deformity (AAFD). METHODS: 84 patients with Stage II AAFD met inclusion criteria with 18 undergoing flatfoot reconstruction and spring ligament (SL) repair with a FiberTape suture device (SL+FT), 12 with suture repair alone (SL+suture), and 54 without repair of the SL. Radiographic measurements were made on weight bearing radiographs pre- and postoperatively at an average of 90 ±108 weeks after surgery. The radiographic measurements included tibiotalar tilt (TT), talar-first metatarsal angle (T1M), talar-second metatarsal angle (T2M), talonavicular uncoverage angle (TN), Meary’s angle (MA), calcaneal pitch (CP), medial column height (MCH), and lateral column height (LCH). Statistical analysis was performed using two-way ANOVA. RESULTS: There were no differences in preoperative radiographic measurements between the three groups. Postoperatively, the SL+FT and SL+suture groups had statistically significantly improved radiographic outcomes for T1M, T2M, TN, MA, CP, and LCH when compared to the no SL repair group (p<0.05). There were no differences in any radiographic outcomes between the SL+FT and SL+suture groups (Figure 1). CONCLUSION: Spring ligament reconstruction with either a FiberTape construct or suture repair alone demonstrates significant improvements in postoperative radiographic outcomes after undergoing flexible flatfoot reconstruction at an average of 2 years after surgery as compared to patients that did not have SL repair. The results of our study support spring ligament repair or reconstruction for patients when performing flexible flatfoot surgery for Stage II AAFD.