E2202. Adult Acquired Flat Foot Deformity: Operative Techniques, Post-Operative Imaging, and Complications
  1. Dylan Constantino; University of Washington
  2. Cody Rissman; University of Washington
  3. Hoiwan Cheung; University of Washington
  4. Alireza Abadi; University of Washington
  5. Parham Pezeshk; University of Texas Southwestern Medical Center
  6. Maryam Soltanolkotabi; University of Utah
  7. Majid Chalian; University of Washington
Acquired adult flatfoot deformity (AAFD) is a complex pathology consisting of posterior tibial tendon insufficiency and failure of the capsuloligamentous supporting structures of the foot arch. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Different classification systems exist for grading the severity of these findings and various surgical methods are being used to correct this progressive pathology. We aim to review the most commonly used surgical approaches used at different grades of AAFD with their potential complications and imaging appearances.

Educational Goals / Teaching Points
A. Review the pathophysiology and radiographic evaluation of AAFD B. Review operative techniques and management strategies for symptomatic AAFD C. Review favorable and complicated postoperative imaging findings of AAFD

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A. Pathophysiology of AAFD B. Normal foot alignment C. Radiographic evaluation of AAFD D. Role of MRI in preoperative assessment of AAFD E. Gradation of disease (Myerson system) and commonly used operative techniques a. Stage I 1. Conservative management 2. Kidner procedure b. Stage II 1. Tendon transfer 2. Medializing calcaneal osteotomy 3. Subtalar arthroereisis 4. Medial column stabilizing procedures/arthrodeses 5. Cotton osteotomy c. Stage III 1. Lateral column lengthening procedures 2. Opening wedge calcaneal osteotomy 3. Calcaneocuboid distraction arthrodesis 4. Triple arthrodesis d. Stage IV 1. Realignment procedures described above with deltoid ligament reconstruction and/or tibiotalar fusion F. Postoperative imaging features a. Tendon transfers 1. Favorable: normal thickness, signal, and course 2. Unfavorable: avulsion, tears, tendinosis, infection b. Osteotomies and arthrodeses 1. Favorable: osseous bridging and mature ankylosis 2. Unfavorable: nonunion, infection c. Subtalar arthroereisis 1. Favorable: expected implant position and appearance 2. Unfavorable: implant migration, infection, fracture

Myerson grading is the most commonly used system to classify AAFD. Familiarity of radiologists to this grading system is crucial to provide clinically useful imaging report. In addition, familiarity with different surgical approaches for AAFD helps radiologists to investigate common pathologies related to each surgical technique.