A new, isolated-fusion technique can remove damaged cartilage and replace it with a small chip of pelvic bone secured by internal fixation. Their pain is along the posterior tibial tendon. It can be sudden, indicating a possible rupture, or insidious, indicating possible degeneration and stretching. A telltale sign is inability or difficulty achieving a normal varus position of the hindfoot when using the forefoot to raise the heel. An MRI scan may help, but the diagnosis can usually be made on physical examination.
Many patients seek surgery because of continued pain, deformity and activity limitations.
Newer techniques include lateral-column lengthening and calcaneal osteotomies.