Vol. 4 No. 1 (2021): American Journal of Surgical Research and Reviews

Modified Putti Procedure for the Surgical Management of Patients with Adult Acquired Cavo-Varus Resulting from Peroneal Tendon Rupture

Joseph Anderson1*; G. Parker Peresko; Sara Grzywa3; Emily Keeter3; Brooke Lynn Anderson4
1Partner at New Mexico Bone and Joint Institute Alamogordo, New Mexico. Fellowship Director at American Foundation of Lower Extremity Surgery and Research. 2Resident at Western Pennsylvania Hospital, Pittsburgh, PA. 3Fellow at the American Foundation of Lower Extremity Surgery and Research Alamogordo, NM. 4First Year Medical Student Midwestern University School of Podiatric Medicine Glendale, AZ.


  • Peroneal Rupture, Cavovarus; tendon transfer; Posterior Tibial Transfer; Acquired Cavovarus; Putti

How to Cite

Joseph Anderson1*; G. Parker Peresko; Sara Grzywa3; Emily Keeter3; Brooke Lynn Anderson4. (2021). Modified Putti Procedure for the Surgical Management of Patients with Adult Acquired Cavo-Varus Resulting from Peroneal Tendon Rupture. American Journal of Surgical Research and Reviews, 4(1), 15. https://doi.org/10.28933/ajsrr-2021-02-1805


Background: Peroneal pathology, including trauma, can result in Cavovarus-Drop Foot type deformity, precluding patients from functioning in or attempting bracing. Lateral ankle stabilization and other associated procedures sometimes are not enough to address the resultant deformity, thus many CavoVarus-Dropfoot patients still have gait abnormalities, function minimally in a brace and still have secondary ambulatory pain and loss of function even when braced. We review the results of 9 patients meeting this criteria and electing for a Modified Putti Procedure and lower extremity reconstruction.

Materials and Methods: The charts of 9 patients with adult-acquired CavoVarus deformity foot type after peroneal rupture were reviewed, all but 1 had failed previous AFO/bracing. These patients underwent surgical correction all consisting of the Modified Putti procedure, along with other ancillary procedures and the results and outcomes were collected. Additionally, surgical technique was documented.

Results: The mean VAS score improved from 9.1 to 2.4 pre- and post-operatively, respectively. The average time to weight bearing was 7.2 weeks. Four of 9 (44.44%) patients experienced some form of complication. Eight of 9 (88.88%) patients relayed the surgery was a success and would opt to undergo it again, given the choice.

Conclusion: The Modified Putti Procedure showed promising results, great patient satisfaction and marked improvement in pre-operative and post-operative pain rating. This technique, utilized after severe peroneal trauma and resultant deformity is present, is a considerable option to have in the foot and ankle surgeon’s armament.


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