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Patient history: 16 year old male soccer player presented with a long standing history of medial ankle and arch pain. He was previously diagnosed with a flexible pes planovalgus and equinus deformity. He tried and failed standard non-surgical modalities over the past two years and was unable to continue playing soccer secondary to the pain. Previous MRI revealed the posterior tibial tenosynovitis without any tearing. He was sent on consultation to discuss surgical intervention secondary to failing standard non-surgical treatment with 7/10 pain on ambulation and deformity. 

Physical exam: Neurovascular status was intact and normal. He had a reducible pes planovalgus deformity with calcaneal valgus on stance, too many toes sign, and flexible forefoot varus. Gastrocnemius equinus was noted per silfverskiold exam. 5/5 muscle strength for all compartments of bilateral lower extremities, but with significant pain on resisted inversion along the posterior tibial tendon. Pain to palpation along the posterior tibial tendon from the medial malleolus to the navicular.

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Operative Treatment: Open Gastrocnemius Lengthening, Medial Displacement Calcaneal Osteotomy, Cotton Osteotomy, Bone Marrow Aspirate, and Posterior Tibial Tenosynovectomy

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Results/Conclusion: Patient was non-weight bearing for 6 weeks and then weight bearing as tolerated in a walking boot for 2 weeks. He was then transitioned into tennis shoes with custom inserts and returned to playing competitive soccer at 4 months post op. He is now 12 months out from surgical intervention with no complains, return of deformity or pain.

Surgeon Comment: The Tarsa-Link™ Stand-Alone Wedge assisted with maintaining correction of the patient’s forefoot deformity through the cotton osteotomy. Tarsa-Link’s unique design allows for low profile internal fixation through the wedge, which provides stability during the bone ingrowth process and prevents hardware irritation. The patient was able to ambulate pain free and return to competitive soccer following the procedure.


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Dr. Kyle T. Pearson DPM, MHA
Board Certified Reconstructive Foot and Ankle Surgeon
Fellow American College of Foot and Ankle Surgeons
Teaching Faculty
KSB Foot and Ankle Surgical Residency Program
Rezin Orthopedics and Sports Medicine
Morris, IL 60450