Marengo Asia Hospital (Formerly Sunshine Global Hospital), Vadodaranr. Shreyas Vidhyalay, behind ICICI Bank, Lalbaug, Manjalpur, Vadodara, Gujarat 390004 / Marengo Asia Hospital (Formerly Sunshine Global Hospital), SuratDumas Rd, beside Big Bazar, Piplod, Surat, Gujarat 395007
Revision Surgery
Reconstructing a Common but Challenging Ankle Malunion
An ankle malunion with iatrogenic tibialis posterior injury, reconstructed after a minimally invasive fixation went wrong — restoring fibular length, rotation and medial stability.
Patient Age
36 Years
MECHANISM
Fall (right ankle)
PRESENTATION
1.5 Years Post-Surgery
APPROACH
MDCO, Deltoid Repair, FDL Transfer
01
Clinical Rationale
Percutaneous fixation of the medial malleolus elsewhere had injured the tibialis posterior tendon, leaving malunion, heel valgus and medial instability. Restoring fibular length and rotation, then transferring FDL, rebuilt the stability the original surgery destroyed.
02
Surgical Approach
Reconstruction addressed each failure in turn: a medial displacement calcaneal osteotomy as the first procedure, deltoid repair, and an FDL transfer to restore the lost tibialis posterior function and correct the planovalgus deformity.
02
Imaging & Progression
Pre-operative imaging, intra-operative exploration and post-operative recovery images. Each slot maps to a CMS image field — drop in the matching consented file from the case folder.
#1
Rotational ankle fractures require careful evaluation and a CT scan before fixation.
#2
Minimally invasive fixation of the medial malleolus is discouraged — periosteal unfolding raises nonunion risk.
#3
Percutaneous screws at the medial malleolus can cause iatrogenic tibialis posterior injury and instability.
#4
Restoration of fibular length and rotation is absolutely essential to a stable result.
04
Clinical Care Points
RIGHT SIDE
- i) MDCO as first procedure
ii) Deltoid repair
iii) FDL transfer for TP function
iv) Restoration of fibular length & rotation
LEFT SIDE
-
| 35+ YEARS OF TRUST, CARE & EXCELLENCE
Reconstructing a Common but Challenging Ankle Malunion
An ankle malunion with iatrogenic tibialis posterior injury, reconstructed after a minimally invasive fixation went wrong — restoring fibular length, rotation and medial stability.
A 36-year-old woman sustained a right ankle fracture after a fall and was treated with closed reduction and percutaneous fixation. Over the following 18 months, she developed medial ankle pain, difficulty walking and a progressively flattening, valgus foot. The worsening deformity indicated that the problem extended beyond the healed fracture itself.
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