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I will start with a discussion of Progressive Collapsing Foot Deformity (PCFD), and I will begin with the end of my lecture on this topic. I am starting at the end to impart two key charts I created summarizing my lecture. PCFD is the newer terminology for Adult Acquired Flatfoot Deformity (AAFD) or Posterior Tibial Tendon Dysfunction (PTTD). The PCFD language originated from a series of consensus statements in Foot and Ankle International (FAI).1-9 Agree or disagree with consensus statements (essentially a white paper); the precedent for them exists in orthopedics.

I believe in surgical principles because they are truths; "a fundamental truth or proposition that serves as the foundation for a system of belief or behavior or for a chain of reasoning." 10 Following evidence-based principles should produce consistent outcomes. The PCFD principles to me include:

"Operative procedures chosen must address the cause of the deformity and, most importantly, must address all components of the deformity to restore biomechanics and function."11

-       Abyar et al. Tech Foot Ankle Surg 2019

We will have a much deeper discussion of how I arrived at the following surgical procedure recommendations for each deformity of PCFD. But first, I hope you find this chart helpful in PCFD cases. One term I use in the chart not well defined in the literature by part of the classification system put forth by the consensus group is subtalar joint (peritalar) subluxation/dislocation and subfibular impingement.

Here is an example of subtalar joint (peritalar) subluxation/dislocation –

Here is an example of subfibular impingement –

Finally, here is the promised chart –

If you enjoyed this blog, please share it, and let me hear from you. Stay diligent.

References:

1.     de Cesar Netto, Cesar, Jonathan T. Deland, and Scott J. Ellis. "Guest editorial: expert consensus on adult-acquired flatfoot deformity." (2020): 1269-1271.

2.     Myerson, Mark S., et al. "Classification and nomenclature: progressive collapsing foot deformity." Foot & Ankle International 41.10 (2020): 1271-1276.

3.     de Cesar Netto, Cesar, et al. "Consensus for the use of weightbearing CT in the assessment of progressive collapsing foot deformity." Foot & ankle international 41.10 (2020): 1277-1282.

4.     Sangeorzan, Bruce J., et al. "Progressive collapsing foot deformity: consensus on goals for operative correction." Foot & ankle international 41.10 (2020): 1299-1302.

5.     C. Schon, Lew, et al. "Consensus for the indication of a medializing displacement calcaneal osteotomy in the treatment of progressive collapsing foot deformity." Foot & ankle international 41.10 (2020): 1282-1285.

6.     Thordarson, David B., et al. "Consensus for the indication of lateral column lengthening in the treatment of progressive collapsing foot deformity." Foot & Ankle International 41.10 (2020): 1286-1288.

7.     Hintermann, Beat, et al. "Consensus on indications for isolated subtalar joint fusion and naviculocuneiform fusions for progressive collapsing foot deformity." Foot & Ankle International 41.10 (2020): 1295-1298.

8.     Johnson, Jeffrey E., et al. "Consensus on indications for medial cuneiform opening wedge (cotton) osteotomy in the treatment of progressive collapsing foot deformity." Foot & Ankle International 41.10 (2020): 1289-1291.

9.     Deland, Jonathan T., et al. "Indications for deltoid and spring ligament reconstruction in progressive collapsing foot deformity." Foot & ankle international 41.10 (2020): 1302-1306.

10.  https://www.google.com/search?q=definition+of+principles

11.  Abyar, Eildar, et al. "Forefoot supination and medial column instability in the setting of AAFD: the role of the medial column." Techniques in Foot & Ankle Surgery 18.3 (2019): 132-140.