To The Editor:

I read with great interest the discussion of the acquired flat foot deformity resulting from the loss of function of the posterior tibial tendon, in the case report “Acquired Flatfoot Deformity Following Posterior Tibial Tendon Transfer for Peroneal Nerve Injury”(1) by Vertullo and Nunley. The common peroneal nerve, which was reportedly divided during excision of a Baker cyst was not recognized during the surgical procedure, and the certainty of a complete transection, cannot be absolutely relied on.

The authors unfortunately did not obtain EMG or NCV studies to confirm a complete transection, with total loss of the evertor muscle function. As manual evaluation of muscle strength is subjective, it is possible that the clinical loss of peroneal muscle function could have been a partial loss, leaving residual peroneal muscle function. This could explain the collapse of the foot that was reported. The authors bring up interesting points, but a bettr documented example would be of assistance in confirming their thoughts.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

Reference:

1. Vertullo CJ, Nunly JA. Acquired flatfoot deformity following posterior tibial tendon transfer for peroneal nerve injury: a case report. J Bone Joint Surg Am. 2002;84: 1214-1217.