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Abstract: A 20-year-old Mr. Wang presented to our hospital with foot discomfort, complaining of foot pain that worsened with activity and was found to have a collapsed arch, heel valgus, and an abnormal gait on physical examination. The magnetic resonance examination confirmed that the flatfoot was caused by posterior tibial tendon dysfunction. Through surgery and medication, Mr. Wang’s condition improved and he was asked to return to the hospital for a review in 1 month.
Basic information】Male, 20 years old
Disease Type】Flatfoot
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of consultation】January 2022
Treatment plan】Surgical treatment (soft tissue transfer repair) + intravenous infusion (cefoperazone sodium tazobactam sodium for injection)
Treatment period】5 days of hospitalization and review after 1 month
Results】The symptoms of flatfoot gradually improved and other accompanying symptoms disappeared.
I. Initial consultation
Mr. Wang, 20 years old, complained of foot discomfort and pain in his feet, which was more severe when he walked fast. Through physical examination, Mr. Wang’s arch was found to be relatively flat. When Mr. Wang was asked to stand and walk, it was found that the arch of Mr. Wang’s foot basically fit the ground, and there was heel valgus, foot bunion valgus, and abnormal gait. Mr. Wang’s magnetic resonance imaging was completed, and it was found that the posterior tibial tendon dysfunction existed in the foot, but there was no soft tissue injury yet, so he was considered to have flatfoot caused by posterior tibial tendon dysfunction, but soft tissue strain had not yet occurred.
II. Treatment history
After comprehensive physical examination and magnetic resonance examination, we considered that Mr. Wang’s flatfoot was caused by posterior tibial tendon dysfunction, resulting in abnormal arch function and then flatfoot, and the situation was relatively serious, so we needed to treat it by soft tissue transfer repair under local anesthesia. After signing the consent form, Mr. Wang was asked to fast and abstain from water before surgery, and the surgical site was disinfected and prepared for skin. By transposing the long toe flexor tendon to reconstruct the function of the posterior tibial tendon, the function and shape of Mr. Wang’s foot arch could be restored to normal. Postoperative intravenous cefoperazone sodium tazotan sodium for injection was administered to prevent infection of the surgical incision. Regular wound dressing changes were performed for Mr. Wang to observe the wound condition.
III. Treatment effect
After 5 days of hospitalization, Mr. Wang’s foot pain disappeared and he had no pain when standing or walking. I found through physical examination that the arch of the foot returned to normal shape and no longer collapsed. After allowing Mr. Wang to stand and walk again, I found that heel valgus, foot bunion and gait were all back to normal, and MRI was performed again to clarify that the posterior tibial tendon dysfunction and flatfoot were corrected. Mr. Wang was discharged from the hospital with a good overall condition and was asked to review in 1 month.
IV. Notes
We are glad that Mr. Wang’s flatfoot was corrected by surgical treatment, but we need to remind Mr. Wang that until the tissues are completely healed, he should pay attention to reduce leg activities and avoid large amplitude movements to avoid affecting the healing of the surgical wound. Avoid wearing tight shoes in daily life, which may squeeze the foot or wear the skin of the foot, and even cause soft tissue damage to the foot.
V. Personal insight
Flatfoot can be caused by abnormal connection of two tarsal bones, genetic factors, foot trauma, long time pressure on the foot, and posterior tibial tendon dysfunction, etc. Mr. Wang’s flatfoot is mainly caused by the abnormal function of posterior tibial tendon, which can be corrected through targeted surgery. To avoid postoperative complications or poor tendon recovery, postoperative foot care, personal diet care, and adjustment of exercise habits are also needed to improve the prognosis.