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I'm currently researching flexor digitorum longus tendon transfer and medial calcaneal displacement osteotomy for the treatment of stage II posterior tibial tendon dysfunction.

I am finding little evidence that the flexor transfer is of any use even when used with the calcaneal osteotomy. There also seems for both procedures to be a conflict of results between radiographic improvement and correction of the medial arch and forefoot abduction with articles stating radiographic improvement in medial cuneiform height, talonavicular angle etc, but then the authors stating that this is not corrective especially in the long term - how much of a difference constitutes good results?

So my question is, why is the use of both techniques still prevalent and do either of them truly have much effectiveness in correcting the flatfoot that occurs with posterior tibial dysfunction?

A biomechanical explanation would be great