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Pediatric Orthopedics > Pediatric Flatfoot > Flashcards

Pediatric Flatfoot Flashcards

1
Q

What is pediatric flatfoot

A

Group of conditions whose common feature is a flattened longitudinal arch

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2
Q

All early walkers present with a flatfoot, true or false

A

True

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3
Q

What are the symptoms of pes valgus deformity?

A

Everted heel position
Abducted forefoot
Collapse of medial column

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4
Q

Describe pes valgus during gait

A

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

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5
Q

Describe the biomechanics of pes valgus deformity

A
  • 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
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6
Q

What are the two types of pediatric flatfoot

A

Structural flatfoot
Functional flatfoot

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7
Q

What are the types of structural flatfoot

A

Tarsal coalition
Congenital vertical talus
Arthritides
Trauma
Iatrogenic

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8
Q

What are the most important types of structural flatfoot

A

Congenital vertical talus
Tarsal coalitions

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9
Q

What are the types of functional flatfoot

A

Ligamentous laxity - Ehlers-Danlos, Marian’s
Accessory tarsal navicular
Os Tibiale Externum
Compensatory
Neuropathy
Myopathy
Muscle Spasm
Congenital pes calcaneovalgus

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10
Q

Describe the phenomenon of functional flatfoot

A

Function with flattened medial longitudinal arch but have sufficient form to retain an arch when NWB
Extremely common in children

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11
Q

Describe the T-C angle on X-ray in pediatric flatfoot

A

More than 30 degrees on WB

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12
Q

Describe the talar-1st MT angle on X-ray in pediatric flatfoot

A

Increased

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13
Q

What is the most common forerunner of pes valgus

A

Congenital calcaneovalgus - limited plantarflexion of the ankle joint and everted positioning of the foot

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14
Q

What are the 3 goals of orthotic therapy in pediatric flatfoot

A
  • increase ground reactive forces medially
  • provide stable surface in shoe
  • improve calcaneal position on ground
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15
Q

How to increase ground reactive forces medially with orthotics for peds plat foot

A

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

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16
Q

How to provide stable surface in shoe with orthotics for peds flat foot

A

Semirid or rigid device
Long rearfoot post
Wide plate

17
Q

How to improve calcaneal position on the ground with orthotics in peds flat foot

A

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

18
Q

Soft tissue pocedures for correction of pes Plano valgus deformity is specific for the _______ column

A

Medial

19
Q

What are 2 soft tissue procedures for pes Plano valgus

A

Kidner procedure
Young procedure

20
Q

What is the kidner procedure

A

Resection of accessory navicular/tuberositm as well as transposition of the insertion of tib posterior tendon o the underside of the navicular

21
Q

What is young procedure

A

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

22
Q

What are the osseous procedures of the medial column for pes Plano valgus

A

Hoke arthrodesis
Talonavicular arthrodesis
STJ Arthroeresis

23
Q

What a the extra-articular osteotomies for pes Plano valgus

A

Anterior calcaneal osteotomy
Posterior osteotomies
Chambers procedure
Selakovich procedure
Vertical lateral approach

24
Q

What is the preferred osteo toy of choice for transverse plane dominant pes valgus deformity

A

Evan’s osteotomy

25
Q

What are the benefits of Evan’s osteomty

A

Preserves joint motions achieves correction in transverse plane, limits excessive heel valgus and provides stability of the both rearfoot and midfoot

26
Q

When are posterior osteotomies useful

A

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

27
Q

What are the posterior varus producing ostetomies

A

Dwyer
Silver

28
Q

What are the posterior medial displacement osteomies

A

Koutsogiannis

29
Q

What is rearfoot arthrodesis used for

A

Severe degenerative joint disease
3 plane deformity with pain
Paralytic c deformity
Tarsal coalitions (intra-articular)
Rupture of TP tendons

Pediatric Orthopedics (18 decks)

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