Surgical Correction of Flatfoot Due to Injury to the Posterior Tibial Muscle Tendon: A Case Report

Aims: This article aims to report and describe the surgical application of a technique that is underrepresented in scientific literature. Presentation of Case: A 44-year-old female patient who was diagnosed with a low-energy sprain of the right ankle, resulting in rupture of the posterior tibial tendon and additional injuries to the ligaments and tendons, presenting with acute flatfoot deformity. Surgical treatment was suggested and a surgical approach involving a reconstruction with a hamstring autograft was performed. Discussion: The posterior tibial tendon (PTT) is crucial for foot movement and is prone to rupture due to its anatomical structure, primarily caused by repetitive stress and ankle fractures. Therefore, the case described is unusual because it involved a complete rupture of the PTT triggered by a low-energy trauma. PTT dysfunction can lead to acquired flatfoot, which occurred in our patient, who was classified as being in stage II of the disease. The recommended treatment for this case is posterior tibial tendon reconstruction through tendon transfer. To achieve this, a hamstring tendon autograft was used without sacrificing the foot tendons with a muscle transfer, a rarely reported situation in the literature, but one that proved to offer better outcomes for the patient. Conclusion: This case report discusses stage II flatfoot from posterior tibial tendon (PTT) rupture due to low-energy trauma. Surgical repair using autografts from gracilis and semitendinosus muscles showed favorable outcomes compared to the traditional flexor digitorum longus tendon method. Further studies are needed to establish consensus on this approach.