The Orthobullets Podcast Podiums | Pediatrics | Rigid Adult Flatfoot
Dec 31, 2025
Dr. John Ketz, an orthopaedic foot and ankle surgeon, shares insights on rigid adult flatfoot. He defines this condition and discusses its common indications for hindfoot and midfoot fusions. John delves into the biomechanics behind posterior tibial tendon dysfunction and the importance of imaging for accurate deformity assessment. He outlines when to consider hindfoot fusion and compares various surgical techniques, emphasizing the evolving preferences in treatment. John's expertise shines through as he addresses outcomes and complex cases, providing valuable insights for practitioners.
AI Snips
Chapters
Transcript
Episode notes
Pathology And Terminology Of Rigid Flatfoot
- Rigid adult flatfoot is a degenerative condition driven largely by posterior tibialis dysfunction and loss of the spring ligament.
- The deformity involves progressive collapse and peritalar subluxation across interconnected hindfoot and midfoot joints.
Image Weight Bearing And Use WBCT
- Obtain weight-bearing foot and ankle radiographs and use weight-bearing CT for significant deformities before planning fusion.
- Evaluate motion across the subtalar, talonavicular, and calcaneocuboid joints because fusing one joint alters biomechanics of others.
When To Prefer Hindfoot Fusion
- Consider hindfoot fusions for stage III rigid deformities and large stage II deformities rather than joint-sparing reconstructions.
- Prefer fusions in older, high-BMI, or low-demand patients because they are more predictable and durable.