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Stage III: Posterior Tibial Tendonitis



- Discussion:
   - following lengthening or rupture of tibialis posterior, pt will develop fixed hindfoot deformity w/ hindfoot valgus and forefoot in abduction;
   - if site of maximal deformity is at talonavicular joint, then an isolated talonavicular or talonavicular & calcaneocuboid may be performed;
   - sub-talar arthrodesis:
          - w/ more significant hindfoot valgus, subtalar arthrodesis may be indicated.
          - note that complete correction of the hindfoot deformity may cause a relative supination deformity of the forefoot (which in turn, 
                 decreases the relative amount of wt bearing of the first metatarsal);
   - triple arthrodesis:
          - indicated only w/ severe midfoot collapse deformities;
          - achilles tendon lengthening will often be required for equinus deformity