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Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Accurate characterization of foot type can facilitate identification of patients at risk for different foot disorders and direct operative treatment. Foot type can be determined qualitatively with visual assessment and quantitatively using arch index (AI), calcaneal pitch (CP), Meary's angle (MA), and foot posture index (FPI). Agreement between various foot typing measures is unclear. The purpose of this study was to assess the agreement between different measurements of foot type. We hypothesized that quantitative measures would have better interrater reliability than qualitative measures, and that visual assessment of foot type would be strongly correlated with radiographic assessment. Methods: Bilateral foot photographs were acquired from 92 asymptomatic participants (50 men, 42 women, mean age of 43.3+- 18.6 years) to assess photographic arch type (PAT) and photographic foot posture (PFP). Hindfoot alignment and lateral radiographs were acquired of each foot to assess calcaneal pitch (CP), Meary's angle (MA), x-ray foot posture (XFP), and x-ray arch type (XAT). Photographs and radiographs were assessed by five reviewers in random order. Foot Posture Index (FPI) was determined through manual exam. Arch Index (AI) was measured on lightbox images. Interrater reliability was assessed using Intraclass Correlation Coefficient (ICC) for continuous variables and Kendall's W for categorical variables. Correlations between measures and sensitivity/specificity were assessed using calcaneal pitch as the reference standard with cavus feet >= 26 degrees and planus feet measuring

Category: Basic Sciences/Biologics; Hindfoot; Other Introduction/Purpose: Flexor digitorum longus (FDL) transfer, in conjunction with osseous procedures, is used routinely for the treatment of posterior tibial tendon dysfunction (PTTD). It is well established however that the relative power of the FDL tendon is significantly inferior than that of the native posterior tibial tendon. The purpose of this study is to systematically evaluate the evidence that supports or refutes the use of an FDL transfer in the surgical treatment of PTTD. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta- Analysis. Using the terms 'flexor digitorum longus OR FDL AND posterior tibial tendon dysfunction OR PTTD OR adult acquired flatfoot OR AAFD' we searched the PubMed/Medline database. Both clinical and biomechanical studies were eligible for inclusion. Results: Forty-one studies met the inclusion criteria, including 31 clinical studies and 10 biomechanical in vitro studies. All 31 clinical studies consisted of Level IV evidence, and support the use of an FDL transfer. There was significant heterogeneity of the clinical evidence due to the variety of concomitant procedures. Of the 10 biomechanical in vitro studies, 2 support the use of an FDL transfer, although these did not assess the procedure in isolation. 8 biomechanical in vitro studies specifically assessing the effect on of an FDL transfer contradict its use for PTTD. Conclusion: There is poor quality clinical evidence to support the use of an FDL transfer for PTTD and the biomechanical literature refutes the use of the procedure. It remains unknown if the clinical improvement reported in the literature can be attributed to the FDL transfer or the concomitant osseous procedures. Additional studies are needed to assess the validity of the FDL transfer and whether alternatives are available to preserve the PTT muscle.