Firecracker procedures Flashcards
what is the goal of treatment for flatfoot surgery?
- increase the GRF medial to the STJ axis to increase supinaotry forces
- slow the progression and prevent secondary deformity and degenerative changes
name some procedures for flatfoot correction.
Evans lengthening osteotomy
Cotton
PCDO
posterior tibial tendon lengthening
Describe the Evans osteotomy.
(for flatfoto correction)
lengthens the lateral column with a bone graft inserted 1.5cm proximal to the CC joint
what are the indications for an Evans osteotomy.
flexible pes planovalgus
no DJD
younger patients
describe the PCDO (posterior calcaneus displacement osteotomy). which way do you slide the calcaneus?
sliding calcaneal osteotomy for tx of flatfoot
-poterior calaneus is slid medially to increase GRF medial to STJ axis
describe the cotton osteotomy.
dorsal opening wedge medial cuneiform osteotomy for correction of flatfoot (creates a more plantarflexed metatarsal)
what is the goal of the cotton osteotomy?
used to reduce elevated 1st ray and FF varus (creates a more plantarflexed metatarsal)
what test can you use to determine if cavus foot is due to forefoot, hindfoot, or combined deformity/
coleman block test- place lateral wedge under the 5th met
what are some soft tissue procedures to correct a cavus deformity?
plantar fascia release
tendon transfers (TATT or STATT)
Jones tenosuspension
Hibbs
what is the indication for a Jones tenosuspension?
FLEXIBLE plantarflexed 1st ray to relieve hallux buckling as in a cavus foot
what is Hibbs procedure?
aims to relieve buckling at digits 2-5 by transfering EDL into lateral cuneiform
What is TATT?
(tibialis anterior tendon transfer)
take the TA from its insertion at the medial aspect of the base of the 1st met and move it laterally; takes it from being a supinator and make it more of a pronator
what is STATT?
(split tibialis anterior tendon transfer)
is a split anterior tibial tendon transfer. Leave half of the tendon in its normal insertion, and take the other half and move it lateral to be sutured to peroneus tertius. Now it becomes a more neutral dorsiflexor rather than having a net supination.
Describe the Jones tenosuspension procedure.
Fusion of hallux IPJ with transfer of EHL to the neck of the first metatarsal
Describe the Dwyer osteotomy.
(for cavus correction)
lateral closing wedge osteotomy of posterior calcaneus to reduce calcaneus varus
which way does the calcaneus move in a Dwyer osteotomy?
move it lateral to get more pronatory force
does teh Dwyer change calcaneal inclination angle?
NO. it only changes varus/valgus position of the calcaneus.
what foot type do you suspect with someone who has chronic inversion ankle sprains/ lateral ankle instability?
cavus foot type - if foot is inverted, peroneal tendons are overworked trying to ever teh foot –> degeneratie changes –> lateral ankle instability
What is the Koutsogiannis osteotomy?
medial translation of posterior calcaneus for flatfoot correction (aka medial calcaneal slide)
what is double calcaneal osteotomy?
Evans with medial calcaneal slide
what is the steindler stripping?
removing all soft tissue from the plantar surface of calcaneus:
FDB, ABDM, ABH
What procedure would you use to surgically correct a Haglund’s deformity?
Keck and Kelly calcaneal osteotomy
Describe the Keck and Kelly procedure..
(tx for Haglund’s deformity)
dorsal closing wedge in the calcaneal tuberosity to remove the painful bump and effectively shortening the calcaneus
What is the eponym for a 1st MPJ arthrodesis?
McKeever
What is the Kidner procedure?
resection of navicular tuberosity followed by transposition of the insertion of tibialis posterior tendon plantarly on the navicular
Which type of plantar fasciotomy allows for spur resection?
open plantar fasciotomy is the only one
What is the purpose of the Weil osteotomy?
shortens and dorsiflexes the capital fragment
describe the osteotomy of the Weil procedure.
dorsal-distal to proximal-plantar distal oblique osteotomy that allows for shortening and dorsiflexion of the capital fragment.
what procedure do you use to shorten a long metatarsal?
Weil osteotomy
What is the Miller procedure?
medial cuneiform- navicular- 1st met fusion
What is the Hoke procedure?
navicular to medial and intermediate cuneiform arthrodesis
What is the Cobb procedure?
(for PTTD)
split TA tendon, transfer to the PT or into the navicular
What is the double calcaneal osteotomy?
Evans with a medial calcaneal slide
