flatfoot/equinus

Question 1

uncompensated equinus clinical symptoms

Answer 1

hypertrophic calves
STJ supinated 
walking plantarflexed 
smaller steppage gait 
RF inverted

Question 2

partially compensated equinus symptoms

Answer 2

early heel off, STJ pronation, mild HAV

Question 3

Fully compensated equinus

Answer 3

forefoot supinatus, STJ pronation, heel valus, HAV defromity

Question 4

what achilles procedure indicated for spastic equinus

Answer 4

Murphy procedure: advancing the insertion of achilles anteriorly on calcaneus, just posterior to the posterior facet of STJ.

Question 5

Forefoot supinatus vs forefoot varus

Answer 5

forefoot supinatus: it is acquired because subtalar pronation allows lowering of medial column to floor

forefoot varus: congenital osseous deformity that INDUCes subtalar joint pronation

Question 6

Young tenosuspension; procedure and goal

Answer 6

used to correct forefoot supinatus

rerouting TA through navicular key hole

Question 7

Lowman procedure

Answer 7

Sagittal plane correction A talonavicular arthrodesis. Procedure involves rerouting the tibialis anterior under navicular and suturing it to the spring ligament.

A lip of achilles tendon is folded forward along the medial arch as an accessory ligament

Question 8

Miller procedure

Answer 8

Sagittal plane correction: TMT and NCJ arthrodesis

Question 9

Hoke procedure

Answer 9

Sagittal plane correction: arthrodesis of medial and intermediate cuneiform with navicula

Question 10

Cotton osteotomy

Answer 10

An opening wedge osteotomy of medial cuneiform. This procedure is performed in order to plantarflex the medial column

Question 11

Chambers osteotomy

Answer 11

a) Typically reserved for patients younger than 8 years of age
b) Procedure involves a bone graft being place under the sinus tarsi in order to block talar motion on calcaneus

Question 12

Baker and Hill

Answer 12

osteotomy with lifting bone graft under the posterior facet

Question 13

Selakovich ostetoomy

Answer 13

opening osteotomy and bone graft of the sustentaculum tali, which restricts abnormal STJ motion

Question 14

Evans osteotomy

Answer 14

Procedure involves an opening osteotomy 1-1.5 cm proximal to the calcaneocuboid joint on the lateral aspect of the calcaneus using an autogenous bone graft
b) Medial base wedge osteotomy shortening the medial column

Question 15

Frontal plane correction

Answer 15

-Gleich
-Dwyer: Contraindicated on patients under 3 years of age
b) Involves an opening wedge from lateral side or closing wedge form medial side of the calcaneus
Koutsogiannis
5. Subtalar Arthroereisis

Question 16

Pts with flexible flatfoot and short achilles tendon, what is a conservative tx for them

Answer 16

heel cup.

children use heel cup whose margin have been increased to 25 mm

Question 17

what orthotic modification will help with excess pronation

Answer 17

medial flare about 1/8” on rearfoot post

Question 18

Genu varum vs genu valgum

Answer 18

genu varum: bow legged

Genu valgum: knocked knees

Question 19

Compensation of tibial varum

Answer 19

STJ pronation

Question 20

Compensation of tibial valgum

Answer 20

STJ supination

Question 21

How should the saw be oriented with a medial calcaneal slide osteotomy

Answer 21

The osteotomy should be placed at a 45° angle to the weight bearing surface of the foot, parallel to the posterior facet of the subtalar joint

Question 22

how much eversion should arthroeresis provide for STJ

Answer 22

appropriate size implant should allow for about 2 to 4 degrees of subtalar joint eversion.

Question 23

Arthroeresis MBA implants allows for how much eversion

Answer 23

4-6 degrees eversion

Question 24

when dissecting down the calcaneus for an evans osteotomy, what do you want to avoid to prevent dorsal displacement of the anterior fragment of the calcaneus

Answer 24

calcaneocuboid ligament

Question 25

If you make your evans osteotomy too proximal, what can consequences be

Answer 25

arthrosis to the middle and posterior facet

Question 26

When is an isolated STJ arthrodesis appropriate for flatfoot?

Answer 26

when there is no rigid forefoot deformity: if there is fixed forefoot supinatus/varus–> will overload lateral column of foot

Question 27

What are some issues with using FDL transfer to PTT

Answer 27

FDL has smaller x-sectional area than PTT (~50%)
FDL has ~28% of PTT strength
PTT can tolerate 2x the amount of plantar load than FDL