Navicular Tubercle Osteotomy for Mobilization of the Posterior Tibial Tendon: A Simple and Effective Technique for Visualization and Repair of the Spring Ligament

Abstract

Repair or reconstruction of spring ligament complex (SLC) is strongly recommended in the surgical treatment of flexible pes planovalgus, as this structure plays a major role in supplying the integrity of the medial longitudinal arch. The SLC is located underneath the terminal portion of the posterior tibial tendon (PTT) and the navicular tubercle, which makes visualization and repair grueling and often inadequate, unless the overlying structures are mobilized and removed temporarily out of its path. Previously defined techniques for mobilizing the terminal portion of the PTT include cutting the tendon body or detaching its distal end from the navicular bone. However, tendon-to-tendon and tendon-to-bone repairs inevitably heal with scar tissue, demonstrate inferior tissue strength and carry the risk of rupture, elongation and loss of function. Any technique that preserves the tendon and its bony attachment during mobilization of the PTT would definitely be more advantageous in terms of postoperative strength and function. This article defines a navicular tubercle osteotomy technique to mobilize the terminal portion of PTT without violating the tendon body or its bony insertion site. This technique provides perfect visualization and access to the SLC, talo-calcaneal joint and deep plantar structures of the foot. It also enables superior initial fixation of the detached fragment compared with tendon-to-tendon or tendon-to-bone fixation, allows scar-free healing at the osteotomy site and permits distalization of the insertion site of the PTT for retensioning.Level of Evidence: IV.