PTTI

Cause

• Hypovascular zone with in 14 mm of insertion to navicular
• Info joint disease
• Females

Assessment

• Presence of arthritis
• Mobility of hind foot (subtalar movement)
• Mobility of forefoot (can the hind foot valgus corrected with out forefoot supinating)
• Integrity of PTT (ruptured or not)
• GS contracture
• Ankle valgus (tilting of talus in wt bearing X-ray )

Johnson Classification

• stage 1: Tenosynovitis,
  • able to do single heel raise test
• Stage 2: Ruptured/dysfunctional T Post
  • Not able to do single heel raise test
  • Flexible heel valgus
  • Mobile ST
• Stage 3:Fixed hind foot valgus
  • Fixed supination and abduction of forefoot
• Stage 4: Ankle valgus

Treatment Stage 1

• Tenosynovectomy
• Medial heel wedge

Stage 2

• FDL transfer to T Post
• Medial calcaneal translation osteotomy
• If fore foot deformity fixed:
  • Supination:Medial cuniform dorsal opening wedge
  • Abduction: Lateral column lenthening
• Heel equinous: TA lengthen

Stage 3

• Triple arthrodesis

Stage 4

• TTC arthrodesis/TAR