A, Patient with erosive osteoarthritis and posterior tibial tendon insufficiency. Note fixed hindfoot, midfoot, and forefoot deformities. Patient required triple arthrodesis. B, Posterior clinical view showing marked heel valgus bilaterally, worse on left. C, Weight-bearing anteroposterior view. With this degree of fixed deformity, “reconstructive” triple arthrodesis is required. Bone grafting is frequently needed.