21- Surgery of the Congenital Foot

Question 1

What is the Hoke arthrodesis?

Answer 1

navicular fusion to the medial and intermediate cuneiform

*utilized in the presence of NC-sagging

Question 2

What is the Lowman procedure?

Answer 2

TN wedge arthrodesis with rerouting of the achilles tendon under the navicular and suture to the spring ligament

Question 3

What are the clinical presentation of convex pes planfovalgus/ vertical talus or congenital pes planovalbus?

Answer 3

• rocker-bottom deformity with prrominent talar head bulge on the medial and plantar aspect of the foot
• forefoot may touch the anterior surface of the tibia
• valgus rearfoot in equinus

Question 4

Describe the Heyman, Herndon, and Strong procedure for metatarsus adductus.

Answer 4

Soft tissue procedure that involves release of the dorsal, interossei, and plantar ligaments of the TMTJ and intermetatarsal joints

Question 5

What structures are released in the Steindler stripping?

Answer 5

ABH, FDB, ABDM
plantar fascia
long plantar ligament

Question 6

Explain the Jones tenosuspension procedure.

Answer 6

Transfer of the EDL tendon to neck of 1st metatarsal with iPJ fusion
(for a flexible plantarflexed 1st ray)

Question 7

What are potential complications of the Jones tenosuspension procedure?

Answer 7

1. Transfer lesion to 2nd metatarsal if 1st ray is elevated too much
2. hallux limitus
3. tendon may not hold the correction
4. failure of the iPJ fusion site

Question 8

Describe the heyman procedure.

Answer 8

transfer of all 5 extensor tendons to their respective metatarsal heads.

Question 9

What are potential complications of the Heyman procedure?

Answer 9

1. claw toes
2. EDL tendonitis
3. tendon may not hold the correction

Question 10

Describe the modified Hibbs procedure.

Answer 10

transfer of the long extensor tendons to the 2nd or 3rd cuneiform; a Jones transfer of the EHL, and anastomosis of the distal stumps of EDL to the EDB tendons
(aids in midtarsal joint dorsiflexion)

Question 11

explain the STATT procedure.

Answer 11

transfer of the lateral half of the tibialis anterior tendon and anastomosed to the peroneus tertius tendon near its insertion into the 5th met base

Question 12

what are some surgical osseous procedures for the cavus foot type?

Answer 12

cole
japas
DFWO

Question 13

explain the cole osteotomy.

Answer 13

dorsal wedge osteotomy in Chopart’s joint to reduce a fixed anterior cavus which extends from the cuboid laterally through teh NC joints medially

Question 14

explain the japas osteotomy.

Answer 14

“V-shaped” osteotomy thru the midfoot (apex proximal) to dorsiflex the foot

a. No bone is excised; the distal forefoot segment is shifted dorsally on the proximal midtarsal segment
b. This maneuver elevates the forefoot and corrects the anterior pes cavus deformity
c. Apex of the V usually occurs within the navicular

Question 15

What is the primary difference in indications between the Cole and Japas osteotomy?

Answer 15

Cole is for more severe deformities and is only performed in the skeletally mature foot.