flatfoot/equinus Flashcards
uncompensated equinus clinical symptoms
hypertrophic calves STJ supinated walking plantarflexed smaller steppage gait RF inverted
partially compensated equinus symptoms
early heel off, STJ pronation, mild HAV
Fully compensated equinus
forefoot supinatus, STJ pronation, heel valus, HAV defromity
what achilles procedure indicated for spastic equinus
Murphy procedure: advancing the insertion of achilles anteriorly on calcaneus, just posterior to the posterior facet of STJ.
Forefoot supinatus vs forefoot varus
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
Young tenosuspension; procedure and goal
used to correct forefoot supinatus
rerouting TA through navicular key hole
Lowman procedure
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
Miller procedure
Sagittal plane correction: TMT and NCJ arthrodesis
Hoke procedure
Sagittal plane correction: arthrodesis of medial and intermediate cuneiform with navicula
Cotton osteotomy
An opening wedge osteotomy of medial cuneiform. This procedure is performed in order to plantarflex the medial column
Chambers osteotomy
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
Baker and Hill
osteotomy with lifting bone graft under the posterior facet
Selakovich ostetoomy
opening osteotomy and bone graft of the sustentaculum tali, which restricts abnormal STJ motion
Evans osteotomy
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
Frontal plane correction
-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
Pts with flexible flatfoot and short achilles tendon, what is a conservative tx for them
heel cup.
children use heel cup whose margin have been increased to 25 mm
what orthotic modification will help with excess pronation
medial flare about 1/8” on rearfoot post
Genu varum vs genu valgum
genu varum: bow legged
Genu valgum: knocked knees
Compensation of tibial varum
STJ pronation
Compensation of tibial valgum
STJ supination
How should the saw be oriented with a medial calcaneal slide osteotomy
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
how much eversion should arthroeresis provide for STJ
appropriate size implant should allow for about 2 to 4 degrees of subtalar joint eversion.
Arthroeresis MBA implants allows for how much eversion
4-6 degrees eversion
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
calcaneocuboid ligament
If you make your evans osteotomy too proximal, what can consequences be
arthrosis to the middle and posterior facet
When is an isolated STJ arthrodesis appropriate for flatfoot?
when there is no rigid forefoot deformity: if there is fixed forefoot supinatus/varus–> will overload lateral column of foot
What are some issues with using FDL transfer to PTT
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
