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Podiatric Surgery II > 4) Clubfoot > Flashcards

4) Clubfoot Flashcards

1
Q

Clubfoot (talipes equinovarus) primary bone deformity

A
  • Talar neck and head
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2
Q

Clubfoot (talipes equinovarus) secondary bone deformity

A
  • Metatarsus adductus
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3
Q

Clubfoot (talipes equinovarus) primary joint deformity

A
  • Talonavicular
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4
Q

Clubfoot (talipes equinovarus) secondary joint contractures

A
  • STJ
  • Ankle joint
  • Midfoot and metatarsophalangeal joints
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5
Q

Talipes equinovarus demographics

A
  • Rate 1 in 1,000 births.
  • Male : Female is 2:1
  • Increased 20 times for siblings.
  • Only 33% of identical twins.
  • 80% success with Ponseti Casting
  • Then remaining 80% success with surgery
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6
Q

3 clubfoot ocmponents

A
  • Ankle equinus
  • Rearfoot varus
  • Forefoot varus
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7
Q

Congenital clubfoot

A
  • Intrinsic (Rigid) structural

- Extrinsic (Supple) positional

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8
Q

Intrinsic (rigid) structural clubfoot (congenital)

A
  • Lower leg atrophy
  • Decreased heel size
  • Deep skin lines
  • Poorly defined med mall
  • Navicular abutting to ankle
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9
Q

Extrinsic (supple) positional clubfoot (congenital)

A
  • More responsive to casting

- If untreated will become rigid

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10
Q

Acquired clubfoot etiologies

A
  • Cerebral palsy
  • Spina bifida
  • Arthrogryphosis
  • Trauma
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11
Q

Neuromuscular acquired talipes equinovarus

A
  • Meningitis
  • Polio
  • Spinal deformities
  • Cerebral palsy
  • Diastematomyelia
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12
Q

Post-traumatic acquired talipes equinovarus

A
  • Spinal of sciatic nerve damage
  • Lower leg trauma or laceration
  • Volkman’s contracture
  • Distal tibial epiphyseal damage
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13
Q

Primary deformity in the talus

A
  • Diminished in size, head and neck med/plantar deviated

- Calcaneus, and navicular can be diminished in size also

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14
Q

Shortening of all soft tissue

A
  • Post tibiofibular ligament
  • Calcaneofibular ligament
  • Bifurcate ligament
  • Flexor tendon contracture
  • Abductor hallucis contracture
  • Deltoid Ligament fused with talo-navicular capsule
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15
Q

Pathological anatomy

A
  • Defect of the talar head and neck
  • Anterior and middle facets abnormally directed medially
  • Posterior facet is normal
  • All muscle insertions are normal
  • Abnormal innervation of the extrinsic musculature
  • Secondary skin, nerve, tendon, vascular, and ligament contractures
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16
Q

“Windswept”

A
  • CV/VT + MA/CF
17
Q

Clubfoot radiographic evaluation

A
  • Sustentaculum sign negative: Not visible due to superimpostion
  • Talo-Calcaneal angle < 15 (normal 20-40)
  • MA angle >30 ( normal 30 at birth, 20 at 1y/o and 15 after 4 y/o)
  • Talar head and neck relative to the body is adducted and plantarflexed
18
Q

Normal talocalcaneal angle

A
  • 20 – 40 degrees
19
Q

Clubfoot talocalcaneal angle

A
  • Less than 15 degrees
20
Q

Conservative casting

A
  • Begin as soon as possible
  • Stretching and manipulation first
  • Reduction Sequence: transverse, frontal, sagittal (Adduction Varus Equinus)
  • Do not evert or over pronate the foot
  • Most effective in first 9 months of age
    Weekly cast changes and manipulation for 6 weeks, then maintained for 3 months with abduction brace and night splints
  • Reserve equinus correction for last = surgery
21
Q

Casting complications

A
  • Navicular subluxation lateral and dorsal =
    Vertical Talus or Rocker bottom
  • Avascular necrosis Talus or stretching the arteries too fast (same as surgery)
  • Damage to growing cartilage
22
Q

Turco incision

A
  • Medial hockey stick over tarsal tunnel
23
Q

Cincinnati incision

A
  • Posterior medial to lateral malleolus
24
Q

Posterior / medial soft tissue release

A
  • Posterior = tendo achilles
  • Medial = Z plasty of the TP, FDL, FHL tendon
  • Release of the medial ankle and STJ capsule, deltoid, talonavicular joint, Spring ligament, interosseous talocalcaneal ligament
  • Plantar Fascia
  • Soft tissue is usually all that is needed
25
Q

Surgery sequence

A
  1. Forefoot
  2. Rearfoot
  3. Ankle
26
Q

Osseous procedures

A
  • Older children with severe deformities
  • Lateral Column shortening
  • Lichtblau, Evans, Ganley
27
Q

Fowler procedure

A
  • Closing base wedge osteotomy on the lateral column then takes that autogenous piece of bone and inserts it into the medial cuneiform osteotomy
  • Indicated for older children with persisted varus in the FF and Midfoot
28
Q

Other osseous procedures

A
  • Dywer = evert the calcaneus body
  • Naviculectomy
  • Talectomy
  • TN, TC, CC individual arthodesis
  • Triple arthrodesis
  • Ankle arthrodesis
  • Pantalar arthrodesis

Podiatric Surgery II (6 decks)

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