Surgical Reconstruction of End-Stage Ankle Arthritis and Concomitant Stage II Posterior Tibial Tendon Insufficient Flat Foot

End-stage degenerative joint disease of the ankle and concomitant ipsilateral Stage II posterior tibial tendon insufficient flat foot is a well known entity. Despite this, treatment options have not been discussed in the orthopaedic literature. A case series consisting of five patients was conducted to determine the efficacy of our treatment proposal. Our surgical treatment included an ankle fusion and concomitant flat foot reconstruction with a medializing calcaneal osteotomy, lengthening calcaneal osteotomy, and flexor digitorum longus transfer. At the final followup visit all patients were content with the results of the procedure, and would have it performed again. Each patient had significant relief of ankle and foot pain, and believed they had improved quality of life and function. Complications included two ankle nonunions treated with revision bone grafting and internal fixation, painful hardware and iliac crest hematoma. We conclude that our method of treatment is a viable option for this complex problem.  A long recovery period should be anticipated and patients should be counseled accordingly. (Journal of Surgical Orthopaedic Advances 20(4):236–240, 2011)