Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Podiatric Surgery II > 3) Pes Cavus Procedures > Flashcards

3) Pes Cavus Procedures Flashcards

1
Q

Pes cavus simple definition

A
  • Primarily a sagittal plane deformity
  • Forefoot is plantarflexed on the rearfoot
  • With or without plantarflexed 1st metatarsal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pes cavus etiology

A
  • Idiopathic
  • Congenital
  • Neuromuscular* (mostly CMT)
  • Acquired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Goals of pes cavus tx

A
  • Look at function requirements and goals of patient
  • Consider conservative options first
  • Most effective with mild flexible deformities
  • Often limited / provide symptomatic relief
  • Accommodative orthotics
  • Bracing (AFO)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pes cavus surgical tx goals

A
  • Plantigrade, stable foot
  • Resist deforming forces
  • Long lasting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Preoperative assessment

A
  • Thorough family history
  • Growth Milestones
  • Patients progression of deformity
  • Rule out paralytic disease (neurological consult)
  • Type of cavus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neurological consult for pes cavus procedures

A
  • Myelodysplasias or Spinal Dysraphisms (spinal bifida occulta)
  • Hereditary motor and sensory neuropathies (CMT)
  • Hereditary Degeneration of spinocerebellar tracts
  • Nerve conduction and EMG studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Type of cavus determination

A
  • Locate apex of deformity

- Position of hindfoot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

JAPAS classification

A
  • Anterior cavus
  • Posterior cavus
  • Combined
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Local anterior cavus

A
  • First metatarsal is plantar flexed lower than the weightbearing area of the heel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Global anterior cavus

A
  • Metatarsals I through V lie lower than the weightbearing of the heel and providing the main deforming force
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Posterior cavus

A
  • Vertical heel – High calcaneal inclination angle

- Calcaneal varus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Combined cavus

A
  • Frontal

- Saggital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Flexible versus rigid deformity

A
  • Coleman block test
  • Posterior block for evaluation of ankle component
  • Does heel evert past inverted or neutral position
  • Can forefoot be reduced with rearfoot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Weightbearing AP radiographic evaluation

A
  • Decreased Talocalcaneal angle
  • Normal or decreased Cuboid Abduction angle
  • Increased forefoot Adductus angle
  • Increased TN joint “congruency”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Weightbearing lateral radiographic evaluation

A
  • Increased calcaneal inclination
  • Normal Cyma line to POSTERIOR break
  • Accentuated “bullet hole” sinus tarsi
  • Decreased talar declination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Calcaneal axial view to rule out

A
  • Structural varus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Meary’s angle

A
  • Formed between lines drawn through the longitudinal axis of the talus and its reference to the bisection of the first metatarsal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hibb’s angle

A
  • Bisection of the longitudinal axis of the calcaneus in reference to the first metatarsal
  • Overall angle number determines the degree of cavus deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cavus deformity utilizing the Hibb’s angle is determined by

A
  • Anything that is < 130°
  • Posterior cavus, this angle will approach 90°
  • Anterior cavus, it will approach 130°
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Coleman Block Test

A
  • Build up the lateral column, suspending 1st ray
  • Removing influence of the 1st metatarsal
  • “Stress pronation x-ray of the STJ” (evaluating the position of the lateral process of the talus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Coleman Block Test flexible vs. rigid

A
  • Lateral process of the talus hits the floor of the sinus tarsi = Flexible Cavus
  • DF wedge of the 1st metatarsal indicated, allowing STJ pronation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cavus procedure categories

A
  • Soft tissus
  • Corrective Osteotomies
  • Fusions (IPJ)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Soft tissue cavus procedures

A
  • ST releases
  • Tendon Transfers
  • Tendon lengthening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Corrective osteotomy cavus procedures

A
  • Hindfoot (Dwyer)
  • Midfoot (Cole)
  • Forefoot (Metatarsal bases)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IPJ fusion

A
  • Malleous correction
  • IPJ release – allowing 1st met dorsiflexion
  • Strengthen flexor power
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Stage II cavus deformity clinical presentation

A
  • Calcaneus - Rigid
  • MTP - Flexible
  • First Ray - Rigid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Stage II cavus deformity surgical approach

A
  • Calcaneus – Dwyer
  • No MTP Release
  • First Ray - DFWO
28
Q

Osseous procedures

A
  • Midtarsal osteotomies
  • Metatarsal osteotomies
  • Tarsal osteotomies
  • Tarsal arthrodesis
29
Q

Soft tissue releases

A
  • Fasciotomies (Pediatric or adolescent patient, adjunctive procedure)
  • Subcutaneous fasciotomy
  • Steindler Stripping
30
Q

Steindler Stripping

A
  • Plantar fascia
  • Abductor hallucis
  • Flexor digitorum brevis
  • Abductor digiti quinti
  • Long plantar ligament is released
  • Casted 3 weeks subsequent to correction - Walking cast 2-3 weeks
31
Q

Cavus foot tendon transfers

A
  • Reduce supination
  • Increase pronation
  • Reduce dropfoot
  • Increase dorsiflexion
32
Q

Tendon transfer considerations

A
  • > 10-11 years of age
  • Rarely effect permanent correction
  • Removal of deforming force in controlling progressive deformity
33
Q

Types of tendon transfers

A
  • Extensor Tendon Transfers (Jones Suspension, Heyman Prodedure, Hibbs)
  • Split Tibialis Anterior Tendon Transfer
  • Peroneus Longus Tendon Transfer
  • Tibialis Posterior Tendon Transfer
  • Peroneus Anastomosis
34
Q

Jones Suspension indications

A
  • Flexible cavus

- Flexible plantarflexed 1st ray

35
Q

Jones Suspension

A
  • EHL transected at IPJ of Hallux, rerouted through hole in 1st Met head
  • Sutured back to itself, proximally
  • Distal stump sutured to EHB
  • IPJ fusion - prevents hammering
36
Q

Jones Suspension mechanics

A
  • Compensates for overpowering peroneus longus and flexor hallucis longus
  • Retrograde plantar buckling of 1st MPJ is released
  • Adjunct to transfers
37
Q

Hibbs Tenosuspension indications

A
  • Flexible Forefoot or metatarsal equinus

- Flexible Cavus with Extensor Substitution

38
Q

Hibbs tenosuspension

A
  • EDL (2,3,4,&5) detached from insertion
  • Tenodesed as group into dorsal foot
  • Distal stumps sutured to corresponding Brevis tendon (4&5 go to 4th Brevis)
39
Q

Hibbs procedure components

A
  • Extensors transfer to the lateral cuneiform
  • Plantar fascia and plantar muscle release
  • TAL
40
Q

Heyman procedure

A
  • Transfer of all five long extensor tendons to respective metatarsal heads
  • of distal stumps of long extensor tendons to short
  • 4th and 5th to short extensor of 4th
41
Q

Heyman procedure complications

A
  • Technically difficult
  • Flexion or abduction deformity of digitis
  • Metatarsal fractures
  • Dehiscence of skin
42
Q

STATT

A
  • Effective adjunctive procedure with flexible cavus

- Pronatory influence across the ST and Midtarsal joints

43
Q

STATT procedure steps

A
  • Tendon split to its insertion site
  • Lateral fibers drawn up through proximal incision
  • Rerouted down peroneus tertius sheath
  • Sutured to peroneus tertius tendon, peroneus brevis, or tenodesed to cuboid
44
Q

STATT incisions (3)

A
  • Near TA insertion site
  • Anterior surface of leg above cruciate ligament
  • Over peroneus tertius, 1 inch proximal to insertion
45
Q

Peroneus Longus tendon transfer

A
  • Detached near cuboid
  • Retrograded proximally, rerouted through lateral intermuscular septum to the anterior compartment, through extensor tendon sheath
  • Inserted into the lesser tarsal area
46
Q

Peroneus longus tendon transfer mechanics

A
  • Increases ankle joint DF power
  • Decreased associated dropfoot deformity
  • Removes deforming force
  • Increases ankle DF and eversion
  • Posterior Tibial tendon transferred through interosseous membrane to dorsal midfoot
47
Q

Posterior tibial tendon transfer attachment points

A
  • Anastomosis to P. Brevis

- 3rd cuneiform / cuboid (interference screw or anchor)

48
Q

Posterior tibial tendon transfer indications

A
  • Anterior group weakness leading to drop foot
49
Q

Posterior tibial tendon transfer complications

A
  • Progressive pes valgus

- Triple arthrodesis or Talocalcaneal fusion

50
Q

Peroneal anastomosis

A
  • Peroneus longus to peroneus brevis at the level of the lateral ankle or at the base of 5th metatarsal
  • Decrease plantarflexory force on the first ray
  • Increasing eversion
51
Q

Midtarsal osteotomies

A
  • Cole
  • Japas
  • McElvenny-Caldwell
52
Q

Metatarsal osteotomies

A
  • DFWO

- Pan metatarsal osteotomies

53
Q

Tarsal osteotomies

A
  • Dwyer

- Samilson

54
Q

Cole procedure

A
  • Dorsal tarsal wedge to reduce fixed anterior cavus
  • Extends from cuboid to navicularcuneiform
  • Wider at medial aspect
  • Subtalar and midtarsal joint motion preserved
55
Q

Cole procedure fixation

A
  • Forefoot manipulated into dorsiflexion
  • Fixated (pins or screws)
  • Non-WB cast immobilization 8 weeks
  • WB cast for additional 4-6 weeks
56
Q

Cole procedure complications

A
  • Delayed union
  • Poor cosmesis and function
  • Results in a shorter, wider, thicker foot
57
Q

JAPAS procedure

A
  • Midtarsal V osteotomy at the apex of the deformity ( navicular )
  • No bone is excised
  • Forefoot shifted dorsally on rearfoot
58
Q

Mcelvenny-Caldwell Procedure

A
  • 1st Metatarsal-cuneiform arthrodesis

- Elevation of 1st metatarsal correcting anterior cavus

59
Q

DFWO

A
  • Dorsiflexory Wedge Osteotomy

- Preserves function of major joints

60
Q

Dwyer Osteotomy

A
  • Lateral closing wedge of the body of the calcaneus
  • Indicated with a rigid calcaneovarus deformtiy
  • Caution with tibial varus
  • Goal is perpendicular calcaneus
  • Sural nerve
  • Staple/Screw fixation
  • Drain
61
Q

Samilson

A
  • Dorsiflexory calcaneal osteotomy

- Dorsal displacement of posterior calcaneus

62
Q

Tarsal Arthrodesis

A
  • Before or after tendon transfers
  • Medial double (STJ and TN fusion)
  • CC arthroplasty vs. fusion
  • Triple arthrodesis
63
Q

Stage II cavus deformity clinical –> surgical decision

A
  • Calcaneus, Flexible –> No Dwyer
  • MTP, Rigid –> MTP release
  • First Ray, Flexible –> No DFWO
64
Q

Forefoot driven cavus

A
  • DFW 1st Metatarsal osteotomy (1st TMT fusion, Jones tenosuspension / IPJ fusion)
  • Plantar fascial release
  • Steindler stripping
  • Peroneal anastomosis vs. tendon transfer
65
Q

Digital – Anterior global/local Flexible deformity and procedure selection

A
  • IPJ – Flexion contracture –> IPJ fusion
  • MPJ – Extension –> Extensor hood release, EHL and EDL lengthening
  • MET – Retrograde plantarflexion –> Jones, Hibbs

Podiatric Surgery II (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions