Patient history: Patient history: 17 year old male who is an avid runner presented with a long standing history of medial arch pain and sinus tarsi pain. He was previously diagnosed with an accessory navicular with medial arch collapse, flexible pes planovalgus, and equinus deformity. He tried and failed standard non-surgical modalities over the past three years and was unable to ambulate or complete high impact activities secondary to the pain. Previous MRI revealed distal/insertional posterior tibial tenodonitis with an accessory navicular. He was sent on consultation to discuss surgical intervention secondary to failing standard non-surgical modalities, 6/10 pain with ambulation, and deformity.
Physical exam: Neurovascular status was intact and normal. He had a reducible pes planovalgus deformity with medial collapse, mild calcaneal valgus on stance, and too many toes sign. Gastrocnemius equinus was noted per silfverskiold exam. 5/5 muscle strength for all compartments of bilateral lower extremities, but pain with resisted inversion. Pain with palpation along the posterior tibial tendon from the medial malleolus to the accessory navicular.
Operative Treatment: Open Gastrocnemius Lengthening, Evans Calcaneal Osteotomy, Bone Marrow Aspirate, and Modified Kidner
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. He is now 6 months out from surgical intervention with no complaints, return of deformity or pain. He is currently preparing for a half marathon.
Surgeon Comment: The Tarsa-Link™ Stand-Alone Wedge unique design allows for internal fixation to be placed within the wedge preventing migration of the wedge during the bone ingrowth/healing process. The Tarsa-Link Wedge with internal screw fixation is placed flush to the cortical margin preventing any form of hardware irritation to the Peroneal Tendons. The design of the wedge also prevents resorption of the graft thus loss of deformity correction, which often occurs with allograft wedges. The patient was able to ambulate pain free and return to his passion of running.
Dr. Kyle T. Pearson DPM, MHA
Board Certified Reconstructive Foot and Ankle Surgeon
Fellow American College of Foot and Ankle Surgeons
KSB Foot and Ankle Surgical Residency Program
Rezin Orthopedics and Sports Medicine
Morris, IL 60450