Pediatric Flatfoot Flashcards
What is pediatric flatfoot
Group of conditions whose common feature is a flattened longitudinal arch
All early walkers present with a flatfoot, true or false
True
What are the symptoms of pes valgus deformity?
Everted heel position
Abducted forefoot
Collapse of medial column
Describe pes valgus during gait
Foot is maximal pronated through the gait cycle with little supination
Ankle equinus is often present
Compensation occurs with early heel off, and collapse of the medial column
Describe the biomechanics of pes valgus deformity
- pes valgus deformity consists of a maximally pronated STJ during WB
- STJ is pronated with calcaneus everted - the T-N and C-C joints become divergent from each other with their axes being parallel
What are the two types of pediatric flatfoot
Structural flatfoot
Functional flatfoot
What are the types of structural flatfoot
Tarsal coalition
Congenital vertical talus
Arthritides
Trauma
Iatrogenic
What are the most important types of structural flatfoot
Congenital vertical talus
Tarsal coalitions
What are the types of functional flatfoot
Ligamentous laxity - Ehlers-Danlos, Marian’s
Accessory tarsal navicular
Os Tibiale Externum
Compensatory
Neuropathy
Myopathy
Muscle Spasm
Congenital pes calcaneovalgus
Describe the phenomenon of functional flatfoot
Function with flattened medial longitudinal arch but have sufficient form to retain an arch when NWB
Extremely common in children
Describe the T-C angle on X-ray in pediatric flatfoot
More than 30 degrees on WB
Describe the talar-1st MT angle on X-ray in pediatric flatfoot
Increased
What is the most common forerunner of pes valgus
Congenital calcaneovalgus - limited plantarflexion of the ankle joint and everted positioning of the foot
What are the 3 goals of orthotic therapy in pediatric flatfoot
- increase ground reactive forces medially
- provide stable surface in shoe
- improve calcaneal position on ground
How to increase ground reactive forces medially with orthotics for peds plat foot
Medial skive - increases supinaroty moment
- wide plate or medial flange - expand surface area under foot
Rigid or semi-rigid plate - 3mm polypropylene for <50 lbs
How to provide stable surface in shoe with orthotics for peds flat foot
Semirid or rigid device
Long rearfoot post
Wide plate
How to improve calcaneal position on the ground with orthotics in peds flat foot
Deep heel cup - improves ground reactive forces in frontal plane on a higher level
Rearfoot post - increases contact area and rearfoot control , increases medial ground reactive force
Medial skive - 2-8mm
Soft tissue pocedures for correction of pes Plano valgus deformity is specific for the _______ column
Medial
What are 2 soft tissue procedures for pes Plano valgus
Kidner procedure
Young procedure
What is the kidner procedure
Resection of accessory navicular/tuberositm as well as transposition of the insertion of tib posterior tendon o the underside of the navicular
What is young procedure
Lengthening of Achilles tendon, rerouting of tib ant tendon through a slot in the navicular without detaching the tendon from its insertion, tib posterior reattachment beneath the navicular
What are the osseous procedures of the medial column for pes Plano valgus
Hoke arthrodesis
Talonavicular arthrodesis
STJ Arthroeresis
What a the extra-articular osteotomies for pes Plano valgus
Anterior calcaneal osteotomy
Posterior osteotomies
Chambers procedure
Selakovich procedure
Vertical lateral approach
What is the preferred osteo toy of choice for transverse plane dominant pes valgus deformity
Evan’s osteotomy
What are the benefits of Evan’s osteomty
Preserves joint motions achieves correction in transverse plane, limits excessive heel valgus and provides stability of the both rearfoot and midfoot
When are posterior osteotomies useful
In frontal plane dominat foot - least prevalent
They shift the ratio of available supination to pronation in the STJ in favor of pronation
They can also be used in conjunction with medial column procedures
What are the posterior varus producing ostetomies
Dwyer
Silver
What are the posterior medial displacement osteomies
Koutsogiannis
What is rearfoot arthrodesis used for
Severe degenerative joint disease
3 plane deformity with pain
Paralytic c deformity
Tarsal coalitions (intra-articular)
Rupture of TP tendons
