equinovarus/ equinovalgus feet Flashcards
1
Q
What is this?
A
- Equinovarus feet
2
Q
What conditions is it seen in?
A
- Cerebral Palsy
- Duchenne Muscular dystrophy
- Residual Clubfoot
- Tibial hemimelia- deficiency
3
Q
What muscle imbalances are seen in equinovarus?
A
- Spacitity of
- Tibialis anterior/ posterior
- Gastro-soleus complex
- absence of ligamentous laxity
4
Q
What is signs and symptoms of equinovarus?
A
Symptoms
- Painful weightbearing over lateral border of foot
- instability during stance phase
Signs
-
Gait analysis
- overactivity of tibialis posterior & /or
- overactivity of tibialis anterior
-
Confusion test
- distinguish if tib post/ant mostly involved
- pt whilst sitting flex hip against resistance
- if foot supinated with dorsifexion, tibalis anterior is overactive- most CP pts
5
Q
What is the tx of equinovarus?
A
Non operative
-
TAL with posterior split transfer to peroneus brevis
- flexible equinovarus
- spastic hemiplegia 4-7 years
-
Rancho technique
- for overactive tibialis anterior
- split tibialis anterior-> cuboid, with TAL & intermuscular lengthening of tibialis posterior
-
Calcaneal osteotomy
- rigid hindfoot varus deformity
- lateral closing osteotomy to calcaneus-> valgus of heel
6
Q
What is this?
A
- Equinovalgus deformity
7
Q
Where is equinovalgus seen in ?
A
- Spastic diplegic and quadriplegic cerebral palsy
- Fibular Hemimelia
8
Q
What does the equinovalgus deformity consist of?
A
- Midfoot abduction
- Heel valgus
- Equinus contracture
- typically bilateral
9
Q
Describe the muscle imbalance in equinovalgus ?
A
Spascitiy of
- Peroneals
- Gastro-soleus complex
Weakness of
- Ligamentous laxity
- Tibialis posterior
- Tibialis anterior
10
Q
What is the biomechanical effect of equinovalgus?
A
- Creates lever arm dysfunction during gait and ankle rocker function
- Pt is weightbearing on medial border of foot & talar head
- external rotation of foot-> instability when push off
11
Q
What are the symptoms and signs of equinovalgus?
A
- Painful callus over talar head 2ary to weightbearing
- abnormal shoe wear
Signs
- bilaterally
- valgus heel deformity- posterior view
- compensatory midfoot supination seen
- midfoot break seen to keep foot plantigrade
12
Q
what is the tx of equinovarus?
A
Non operative
- Bracing AFO or supramalleolar orthosis and PT
- flexible deformity
- Botox injections
Surgery
-
Calcaneal osteotomy and soft tissue procedures
- for rigid deformities
- TAL & peroneus brevis Lengthening
- calcaneal osteotomy- medial side osteotomy or calcaneal lengthening osteotomy
-
Grice Proceedure
- extra-articular subtalar arthrodesis
- place bonegraft in lateral subtalar joint to block valgus
- avoids effects on tarsal bone growth
