Progressive Collapsing Foot Deformity
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Published:
Apr 30, 2025
Keywords:
Flatfoot, posterior tibial tendon, classification, collapsing deformity
Main Article Content
Abstract
Adult-acquired flatfoot deformity is a complex orthopedic condition that was redefined with a new nomenclature and classification system published in 2020. In this article, we critically examine the newly introduced concepts, including the use of weightbearing computed tomography, detailing the changes in terminology and classification of the deformity and their clinical relevance. Additionally, we review current studies that support and refine this classification and identify areas for future research.
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How to Cite
Catá, E., Porta, J., & Toledo, I. (2025). Progressive Collapsing Foot Deformity. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(2), 177-184. https://doi.org/10.15417/issn.1852-7434.2025.90.2.1997
Section
Review article
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References
1. Lintz F, de Cesar Netto C. Is advanced imaging a must in the assessment of progressive collapsing foot deformity? Foot Ankle Clin 2021;26(3):427-42. https://doi.org/10.1016/j.fcl.2021.05.001
2. Barbachan Mansur NS, Lalevee M, Maly C, Dibbern K, Lee HY, Godoy-Santos AL, et al. Association between middle facet subluxation and foot and ankle offset in progressive collapsing foot deformity. Foot Ankle Int 2022;43(1):96-100. https://doi.org/10.1177/10711007211040820
3. de Cesar Netto C, Deland JT, Ellis SJ. Guest editorial: Expert consensus on adult-acquired flatfoot deformity. Foot Ankle Int 2020;41(10):1269-71. https://doi.org/10.1177/1071100720950715
4. Myerson MS, Thordarson DB, Johnson JE, Hintermann B, Sangeorzan BJ, Deland JT, et al. Classification and
nomenclature: progressive collapsing foot deformity. Foot Ankl Int 2020;41(10):1271-6. https://doi.org/10.1177/1071100720950722
5. Sangeorzan BJ, Hintermann B, de Cesar Netto C, Deland JT, Ellis SJ, Johnson JE, et al. Progressive collapsing foot
deformity: consensus on goals for operative correction. Foot Ankle Int 2020;41(10):1299-1302.
https://doi.org/10.1177/1071100720950759
6. Ellis SJ, Johnson JE, Day J, de Cesar Netto C, Deland JT, Hintermann B. et al. Titrating the amount of bony
correction in progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1292-5.
https://doi.org/10.1177/1071100720950741
7. de Cesar Netto C, Myerson MS, Day J, Ellis SJ, Hintermann B, Johnson JE, et al. Consensus for the use of
weightbearing CT in the assessment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1277-82.
https://doi.org/10.1177/1071100720950734
8. Schon LC, de Cesar Netto C, Day J, Deland JT, Hintermann B, Johnson J, et al. Consensus for the indication of a
medializing displacement calcaneal osteotomy in the treatment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1282-5. https://doi.org/10.1177/1071100720950747
9. Thordarson DB, Schon LC, de Cesar Netto C, Deland JT, Ellis SJ, Johnson JE, et al. Consensus for the indication of lateral column lengthening in the treatment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1286-8. https://doi.org/10.1177/1071100720950732
10. Johnson JE, Sangeorzan BJ, de Cesar Netto C, Deland JT, Hintermann V, Schon L, et al. Consensus on indications for medial cuneiform opening wedge (Cotton) osteotomy in the treatment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1289-91. https://doi.org/10.1177/1071100720950739
11. Hintermann B, Deland JT, de Cesar Netto C, Ellis SJ, Johnson JE, Myerson M, et al. Consensus on indications for
isolated subtalar joint fusion and naviculocuneiform fusions for progressive collapsing foot deformity. Foot Ankle
Int 2020;41(10):1295-8. https://doi.org/10.1177/1071100720950738
12. Deland JT, Ellis SJ, Day J, de Cesar Netto C, Hintermann B, Myerson M, et al. Indications for deltoid and spring
ligament reconstruction in progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1302-6.
https://doi.org/10.1177/1071100720950742
13. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 1989;(239):196-206.
PMID: 2912622
14. Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendón. Instr Course Lect 1997;46:393-405. PMID: 9143981
15. Bluman EM, Title CI, Myerson MS. Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 2007;12(2):233-49, v. https://doi.org/101016/j.fcl.2007.03.003
16. Raikin SM, Winters BS, Daniel JN. The RAM classification: a novel, systematic approach to the adult-acquired
flatfoot. Foot Ankle Clin 2012;17(2):169-81. https://doi.org/10.1016/j.fcl.2012.03.002
17. Richter M, Zech S. Lengthening osteotomy of the calcaneus and flexor digitorum longus tendon transfer in flexible flatfoot deformity improves talo-1st metatarsal-Index, clinical outcome and pedographic parameter. Foot Ankle Surg 2013;19(1):56-61. https://doi.org/10.1016/j.fas.2012.10.006
18. Lee HY, Barcachan Mansur NS, Lalevee M, Dibbern KN, Myerson MS, Ellis SJ, et al. Intra-and interobserver
reliability of the new classification system of progressive collapsing foot deformity. Foot Ankle Int 2022;43(4):582-
9. https://doi.org/10.1177/10711007211058154
19. Li S, Zhu M Gu W, Hamati M, Hunt KJ, de Cesar Netto C, et al. Diagnostic accuracy of the progressive collapsing foot deformity classification. Foot Ankle Int 2022;43(6):800-9. https://doi.org/10.1177/10711007221078000
20. de Cesar NC, Godoy-Santos AL, Saito GH, Lintz F, Siegler S, O’Malley MJ, et al. Subluxation of the middle facet
of the subtalar joint as a marker of peritalar subluxation in adult acquired flatfoot deformity: a case-control study. J Bone Joint Surg Am 2019;101(20):1838-44. https://doi.org/10.2106/JBJS.19.00073
21. de Cesar NC, Silva T, Li S, Mansur NS, Auch E, Dibbern K, et al. Assessment of posterior and middle facet
subluxation of the subtalar joint in progressive flatfoot deformity. Foot Ankle Int 2020;41(10):1190-7.
https://doi.org/10.1177/1071100720936603
22. Monteagudo M, Martínez de Albornoz P. Progressive collapsing foot deformity. Is there really a Johnson and Strom Stage I? Foot Ankle Clin 2021;26(3):443-63. https://doi.org/10.1016/j.fcl.2021.05.002
23. Boakye LA, Uzosike AC, Bluman EM. Progressive collapsing foot deformity: should we have staging it differently? Foot Ankle Clin 2021;26(3):417-25. https://doi.org/10.1016/j.fcl.2021.06.002
2. Barbachan Mansur NS, Lalevee M, Maly C, Dibbern K, Lee HY, Godoy-Santos AL, et al. Association between middle facet subluxation and foot and ankle offset in progressive collapsing foot deformity. Foot Ankle Int 2022;43(1):96-100. https://doi.org/10.1177/10711007211040820
3. de Cesar Netto C, Deland JT, Ellis SJ. Guest editorial: Expert consensus on adult-acquired flatfoot deformity. Foot Ankle Int 2020;41(10):1269-71. https://doi.org/10.1177/1071100720950715
4. Myerson MS, Thordarson DB, Johnson JE, Hintermann B, Sangeorzan BJ, Deland JT, et al. Classification and
nomenclature: progressive collapsing foot deformity. Foot Ankl Int 2020;41(10):1271-6. https://doi.org/10.1177/1071100720950722
5. Sangeorzan BJ, Hintermann B, de Cesar Netto C, Deland JT, Ellis SJ, Johnson JE, et al. Progressive collapsing foot
deformity: consensus on goals for operative correction. Foot Ankle Int 2020;41(10):1299-1302.
https://doi.org/10.1177/1071100720950759
6. Ellis SJ, Johnson JE, Day J, de Cesar Netto C, Deland JT, Hintermann B. et al. Titrating the amount of bony
correction in progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1292-5.
https://doi.org/10.1177/1071100720950741
7. de Cesar Netto C, Myerson MS, Day J, Ellis SJ, Hintermann B, Johnson JE, et al. Consensus for the use of
weightbearing CT in the assessment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1277-82.
https://doi.org/10.1177/1071100720950734
8. Schon LC, de Cesar Netto C, Day J, Deland JT, Hintermann B, Johnson J, et al. Consensus for the indication of a
medializing displacement calcaneal osteotomy in the treatment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1282-5. https://doi.org/10.1177/1071100720950747
9. Thordarson DB, Schon LC, de Cesar Netto C, Deland JT, Ellis SJ, Johnson JE, et al. Consensus for the indication of lateral column lengthening in the treatment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1286-8. https://doi.org/10.1177/1071100720950732
10. Johnson JE, Sangeorzan BJ, de Cesar Netto C, Deland JT, Hintermann V, Schon L, et al. Consensus on indications for medial cuneiform opening wedge (Cotton) osteotomy in the treatment of progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1289-91. https://doi.org/10.1177/1071100720950739
11. Hintermann B, Deland JT, de Cesar Netto C, Ellis SJ, Johnson JE, Myerson M, et al. Consensus on indications for
isolated subtalar joint fusion and naviculocuneiform fusions for progressive collapsing foot deformity. Foot Ankle
Int 2020;41(10):1295-8. https://doi.org/10.1177/1071100720950738
12. Deland JT, Ellis SJ, Day J, de Cesar Netto C, Hintermann B, Myerson M, et al. Indications for deltoid and spring
ligament reconstruction in progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1302-6.
https://doi.org/10.1177/1071100720950742
13. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 1989;(239):196-206.
PMID: 2912622
14. Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendón. Instr Course Lect 1997;46:393-405. PMID: 9143981
15. Bluman EM, Title CI, Myerson MS. Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 2007;12(2):233-49, v. https://doi.org/101016/j.fcl.2007.03.003
16. Raikin SM, Winters BS, Daniel JN. The RAM classification: a novel, systematic approach to the adult-acquired
flatfoot. Foot Ankle Clin 2012;17(2):169-81. https://doi.org/10.1016/j.fcl.2012.03.002
17. Richter M, Zech S. Lengthening osteotomy of the calcaneus and flexor digitorum longus tendon transfer in flexible flatfoot deformity improves talo-1st metatarsal-Index, clinical outcome and pedographic parameter. Foot Ankle Surg 2013;19(1):56-61. https://doi.org/10.1016/j.fas.2012.10.006
18. Lee HY, Barcachan Mansur NS, Lalevee M, Dibbern KN, Myerson MS, Ellis SJ, et al. Intra-and interobserver
reliability of the new classification system of progressive collapsing foot deformity. Foot Ankle Int 2022;43(4):582-
9. https://doi.org/10.1177/10711007211058154
19. Li S, Zhu M Gu W, Hamati M, Hunt KJ, de Cesar Netto C, et al. Diagnostic accuracy of the progressive collapsing foot deformity classification. Foot Ankle Int 2022;43(6):800-9. https://doi.org/10.1177/10711007221078000
20. de Cesar NC, Godoy-Santos AL, Saito GH, Lintz F, Siegler S, O’Malley MJ, et al. Subluxation of the middle facet
of the subtalar joint as a marker of peritalar subluxation in adult acquired flatfoot deformity: a case-control study. J Bone Joint Surg Am 2019;101(20):1838-44. https://doi.org/10.2106/JBJS.19.00073
21. de Cesar NC, Silva T, Li S, Mansur NS, Auch E, Dibbern K, et al. Assessment of posterior and middle facet
subluxation of the subtalar joint in progressive flatfoot deformity. Foot Ankle Int 2020;41(10):1190-7.
https://doi.org/10.1177/1071100720936603
22. Monteagudo M, Martínez de Albornoz P. Progressive collapsing foot deformity. Is there really a Johnson and Strom Stage I? Foot Ankle Clin 2021;26(3):443-63. https://doi.org/10.1016/j.fcl.2021.05.002
23. Boakye LA, Uzosike AC, Bluman EM. Progressive collapsing foot deformity: should we have staging it differently? Foot Ankle Clin 2021;26(3):417-25. https://doi.org/10.1016/j.fcl.2021.06.002