Vol. 7, Issue 2, Part B (2025)

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Progressive Collapsing Foot Deformity is characterized by collapse of the medial longitudinal arch, hindfoot valgus, and forefoot abduction. Traditionally attributed to posterior tibial tendon dysfunction, recent evidence suggests ligament rupture as the initiating event. Treatment has become increasingly individualized, combining different surgical techniques according to deformity stage and pattern.

We report the case of a former elite athlete affected by Progressive Collapsing Foot Deformity and chronic foot pain secondary to an old sports injury. Imaging revealed degenerative changes in the tibiotalar, talonavicular, and calcaneocuboid joints, soft tissue calcifications, and an accessory navicular bone. CT confirmed severe osteoarthritic alterations and possible prior avulsion of the medial collateral ligament. Surgical treatment included a Koutsogiannis calcaneal osteotomy to realign the hindfoot and a medial column arthrodesis with a Variax plate with Cotton effect involving the talonavicular and naviculocuneiform joints to restore the longitudinal arch and achieve medial stability. Deltoid and spring ligaments were reconstructed with suture-tape and anchors. Postoperatively, the patient was immobilized in a cast, transitioned to a walker boot at 3 weeks, and began partial weight-bearing at 4 weeks.

At 1 month, radiographs showed satisfactory alignment without complications. A rehabilitation program was initiated. At 3 months, the patient achieved independent ambulation, good ankle range of motion, and full correction of the deformity, with maintained alignment and early consolidation. At 10 months, CT demonstrated hindfoot realignment, near-complete resolution of calcifications, fusion of the talonavicular joint, non-union of the naviculocuneiform joint, and apparent restoration of the medial arch.

This case illustrates end-stage medial ankle instability likely caused by previous ligament rupture and highlights the effectiveness of combining hindfoot realignment, medial column stabilization, and ligament reconstruction in advanced Progressive Collapsing Foot Deformity. Tailored surgical reconstruction can restore function and alignment, even in elderly yet highly active patients.