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OrthoVellum

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Foot & Ankle
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Adult-Acquired Flatfoot Deformity - PTT Dysfunction and Johnson-Strom Classification

Adult Flatfoot

A 52-year-old obese woman presents with progressive medial ankle pain and flattening of her right foot over 18 months. She reports difficulty with single-leg heel raise. Examination reveals hindfoot valgus that corrects with heel rise, forefoot abduction ("too many toes sign"), and tenderness along the posterior tibial tendon. Single-leg heel rise test is weak compared to the contralateral side. Regarding adult-acquired flatfoot deformity (AAFD) and posterior tibial tendon (PTT) dysfunction:

Mark each as TRUE or FALSE

A

The Johnson-Strom classification describes 3 stages of PTT dysfunction: Stage I involves tenosynovit...

B

The Myerson modification added Stage IV which includes ankle valgus tilt due to deltoid ligament inc...

C

Stage II AAFD is best treated with isolated PTT debridement and repair; the medial displacement calc...

D

The "too many toes" sign is assessed from behind the patient and indicates forefoot abduction; norma...

E

Stage II surgical options include medial displacement calcaneal osteotomy (MDCO), flexor digitorum l...

Answer the questions to see explanations

Click T (True) or F (False) for each option