Metatarsus Adductus Flashcards
What is met adductus
Uniplanar deformity
Position or structural transverse plane deformity of the metatarsals at the tarsometatarsal (LisFranc’s) joint level
What is the most significant angular relationship in the diagnosis of the metatarsus adductus
Metatarsals adductus
‘What are some clinical findings of met adductus
C-shaped foot - convex lateral border, concave medial border, apparent high arch
Prominent 5th MT tuberosity
Abduction of MT 1-5 in transverse plane
Possible FF varus
May see separation of great toe
Heel-forefoot bisection is not parallel
Lack of abduction past midline
Muscle (TA) hyperactivity
What is the most common form of met adductus
Milf to moderate
What is the appearance of compensated juvenile Met adductus
Rearfoot is pronated
Develop a collapsing flexible pes planovalgus
Not a true MA
Positional deformity
What does compensated adult met adductus look like
Skewfoot
Z-foot
Serpentine foot
Juvenile bunions
Flexor stabilization hammertoes
Tailors bunion
Splay foot
What does uncompensated met adductus look like
Cavus foot type aka cave adductovarus
Rigid forefoot valgus - tripod effect, rigid forefoot valgus
Extensor substitution hammertoes - dynamic swing phase induced hammertoes
When do you see extensor substitution hammertoes vs flexor stabilization hammertoes in metadducts
Extensor substitution in uncompensated met adductus
Flexor stabilization in compensated adult
What is the met adductus angle
Lesser tarsus axis with bisection of 2nd MT axis
What is a normal met adductus angle
15 degrees
What is a mild met adductus angle
15 -20 degrees
What is a moderate met adductus angle
21-25 degrees
What is a severe met adductus angle
Greater than 25 degrees
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Describe the MA angle on DP view
Increased (>15 degrees)
Describe the 2nd metatarsal cuneiform angle on DP view in MA pts
Increased (greater than 24 degrees)
Describe the talar axis on DP view in MA pt
Medial deviation
Describe the cyma line on DP view in MA pt
Anterior break in cyma line
Describe kite’s angle on DP view in MA pts
Increased
Describe the calcaneal inclination angle on lateral view in MA pt?
Decreased
Describe the talar declination angle on lateral view in MA patient
Decreased
Describe cyma line on lateral view in MA pts
Posterior break
Describe MA on radiograph using navicular and kite;s angle
Navicular lateral
Increased kite’s angle
Describe clubfoot on radiograph using navicular and kites angle
Navicular medial
Decreased kite’s angle (< 15 degrees)
When is surgical correction of MA advocated for in peds pt?
After 2 years, following unsuccessful results with conservative treatment
What is one soft tissue ligamentous release performed for peds for MA
Hey man Herndon Strong (HHS)
2-5 years
When are osseous procedures typically performed for peds pt with MA
Greater than 6 years - to evaluate growth plate
Describe the Heyman, Herndon and Strong procedure
Complete mobilization of tarsometatarsal and intermetatarsal ligaments
Heyman Herndon & Strong procedures is a/an _______ caspulotomy
Anterior
Which ligaments must be preserved in Heyman, Herndon & Strong procedure
Plantar-lateral ligaments
What fixation is used for Heyman, Herndon & Strong procedure
K wire fixation
What is the post op course for Heyman, Herndon & Strong procedure
Cast immobilization for 3 months
Describe the Johnson wedge chodrotomies for MA
Age - 6-8
Closing base wedge osteotomy of 1st MT
Take out cartilage of bases 2-5
Describe the McCormick and Blount osteotomy of MA peds pt
- recommended after skeletal maturity
1st metatarsal cuneiform arthrodesis
Closing wedge resection out of cuboid
Lateral wedge osteotomied of bases of MT 2-4
Describe Fowler procedure for MA peds pt
- opening wedge on medial cuneiform with insertion of bone graft
- Used for transverse plane correction
- performed on pts greater than 12 yrs old
Describe steyler and van der Walt osteotomy on MA peds pt
- V-shaped osteotomies
- wedge osteotomies of all the metatarsal bases
- osteotomies were not fixated
- felt osteotomies were more stable and would prevent inadvertent displacement of the distal fragment
Describe Berman and Gartland osteotomy for peds MA pt
Crescent or dome shaped osteotomies of all metatarsal bases
May fix only 1st, 5th and 3rd metatarsal osteotomies ( vassal principle)
Describe lepird procedure for peds MA pt
- oblique closing wedge osteotomies of 1st and 5th MT bases
- MT rotational osteotomied of 2nd, 3rd and 5th MTS
- central 3 MTs performed in transverse plane
Describe grumbling procedure for peds MA pt
Opening wedge on medial cuneiform with cuboid decancellation
Recommendation for 0-2 yr old MA pt
Soft tissue manipulations, stretching, exercise, serial casting
recommendation for 2-5 yo MA pt
HHS procedure
Recommendation of 6-8 yo MA pt
Johnson wedge chondrotomy
Recommendation for MA pt greater than 8
Various other procedures
Leprid, Fowler etc
