Flatfoot Flashcards
What compensation occurs with equinus in a pes valgus foot?
early heel off
STJ and MTJ pronation
medial column sag
TMTJ breech
if a transverse plane deformity predominates, what kind of surgical correction would be indicated?
Evans osteotomy
what radiographic findings would be indicative of a frontal plane dominant deformity?
- widening of the lesser tarsal area on DP view
- decrease of the 1st met declination angle
- decrease of height of sustentaculum tali
- increased superimposition of lesser tarsals on lateral view
axis-altering arthroereisis (i.e. STA-peg) are used for flatfoot deformitiy exhibiting primarily what plane of deformity?
frontal plane
what are some causes of rigid pronated feet?
vertical talus (congenital convex pes planovalgus)
tarsal coalition
peroneal spastic flatfoot
improperly corrected clubfoot
Describe the axis of teh STJ.
42 deg from transverse
16 deg from sagittal
what is the Hubscher maneuver?
in relaxed stance, the hallux is passively dorsiflexed to determine the flexibility of the arch. With passive dorsiflexion, the windlass effect is invoked, and this tightens the medial band of plantar fascia and FHL increasing the height of the arch
what is the Kidner procedure?
resection of accessory navicular and transposition of the insertion of the tibialis posterior tendon to the underside of the navicular
DEscribe the Young tenosuspension procedure.
rerouting the TA tendon thru a slot in the navicular w/o detaching the tendon from its insertion; tibialis posterior reattachment beneath the navicular and TAL if needed
What does the Young’s tenosuspension serve to accomplish?
- removes dorsiflexory force of TA on the 1st met and provides a mechanical advantage to plantarflexory force of PL to recreate medial column
- distal portion of the tendon will become a strong ligament in the medial arch, running from the plantar
aspect of the first metatarsal to the plantar aspect of
the navicular - TA continues to function as primary dorsiflexor of the foot and ankle
- TA continues to invert the foot along the MTJ
Where is the osteotomy made for the evans procedure?
approx 1.5cm proximal to the CC joint
how is the Evans osteotomy directed and why?
directed anteriorly to avoid the middle facet of the STJ
Describe the Dwyer osteotomy
opening wedge with base laterally with bone graft (to correct cavus foot)
or reverse dwyer which is a medially-based closing wedge
is the STJ axis fell parallel to the transverse plane, motion around the axis would primarily be in which plane?
frontal plane
if the STJ axis is more vertical, what plane of motion will be dominant?
transverse plane
imbalance or dysfunction of what muscle will quickly lead to a pes valgus deformity?
tibialis posterior
what deformity is a contraindication for an Evans procedure? why?
met adductus; will cause exaggeration of the met adductus and in-toe gait
what muscle will be encountered when performing the Evans procedure?
EDB muscle belly
what muscles and tendons will be visible when dissecting for Young’s procedure?
TA tendon, TP tendon, ABH muscle
what is the size of the bone graft used with the Evans procedure?
8-10mm (can’t do much larger because of increased CCJ pressure)
ligamentous laxity can occur due to a defect in collagen synthesis. Name these disorders.
Ehlers-Danlos syndrome
Marfans syndrome
osteogenesis imperfecta
instability of which column of the foot is more indicative of pathological flatfoot condition?
lateral column
what are radiographic findings for a flatfoot with sagittal plane dominance?
increased talar declination angle
naviculocuneiform breech
increased talocalcaneal angle on lateral view
decreased calcaneoinclination angle
posterior calcaneal osteotomies are most useful in the correction of flatfoot with what dominant plane of deformity?
frontal plane
in what type of patient is usually arthroereisis performed?
adolescents (have not reached skeletal maturity)
what are the primary and secondary goals for surgical correction of flatfoot deformity?
1) restoration of joint stability
2) restoration of height of teh arch
describe the cyma line in a pronated foot.
anterior break in the cyma line
what is Kite’s angle?
talocalcaneal angle
what is an adjunctive procedure for a flatfoot correction?
TAL (for equinus)
what is the most common cause of peroneal spastic flatfoot?
tarsal coalition
for arthroeriesis to be effective, what must be reducible?
heel valgus as well as FF supinatus/varus
which procedure elevates the posterior facet by insertion of a lateral bone graft beneath it?
Baker-Hill
where is the osteotomy and bone grafting performed for a Selakovich procedure?
sustentaculum tali
what special radiographic views would be helpful in evaluating a patient with flatfoot deformity?
- charger view (stress DF) lateral view - assess for osseous equinus
- Harris and BEath views- for tarsal coalition
- neutral position WB DP and lateral views
Which calcaneal osteotomy uses a bone graft under the sinus tarsi to block translocation of the talus under the calcaneus?
Chambers
Describe the Koutsigiannis osteotomy.
medial displacement osteotomy of the calcaneus
what radiographic findings are seen with a transverse plane dominant deformity?
- increased talocalcaneal angle on DP
- increased cuboid abduction angle
- increased percetnage of TN uncovering
- decreased forefoot adductus angle
