Pes planus Flashcards
Kite’s angle
15-35
Transverse plane
Bisect talus and calcaneus AP view
Cuboid abduction
0-5
Transverse plane
Lateral border of cuboid and calcaneus AP view
Talar head uncoverage
0-30%
Transverse plane
Amount of talar cartilage uncovered by navicular bone
Meary’s angle
0-10
Sagittal plane
Bisect talar head and 1st met Lateral view
Calcaneal inclination
18-20ish
Sagittal plane
Inferior border of calcaneus and the ground lateral view
Talar declination
18-20ish
Sagittal plane
Bisection of head of the talus and the ground lateral view
Cyma line
Curved line that connects the TN and the CC joints on the lateral view. This line should be continuous
STJ angles
42 from transverse
16 from sagittal
STJ ROM
Mostly equal amounts inversion/eversion and abduction/adduction
MTJ oblique
52 from transverse
57 from sagittal
MTJ Longitudinal
15 from transverse
9 from sagittal
MTJ ROM
Oblique axis is mostly pronation/supination
Longitudinal axis is mostly inversion/eversion
Heel rise test
Patient stands on tip toes and the valgus heel should invert
Hubscher maneuver
Dorsiflexion of the hallux should cause the arch to rise
RCSP and NCSP
Measures bisection of the heel as compared to the ground when standing relaxed and neutral STJ, respectively
Tibial influence
Measures bisection of the tibia as compared to the floor with patient standing
Stage I PTTD
Medial ankle pain along PTT
Patient able to perform single and double heel rise
No radiographic changes
Stage IIa PTTD
Medial ankle pain along PTT
Flexible heel valgus
Heel inverts with double heel rise
Stage IIb PTTD
Medial ankle pain along PTT
Increased heel valgus as compared to stage II
Flexible
Heel inverts with heel rise
Stage III
Rigid deformity
Pain located medial and lateral
Stage IV
Rigid deformity
Ankle joint degeneration
FDL transfer
Can be used in all stages
Cobb procedure
Split TA transfer, transfer through a drilled hole in the navicular or medial cuneiform
Young tenosuspension
Rerouting half the TA through the navicular bone
Kidner procedure
Resection of accessory navicular and reinsertion of the PTT into the navicular
Evans procedure
Lateral column lengthening via the lateral surface of the calcaneus. Transverse plane.
Cotton osteotomy
Medial cuneiform opening wedge. Plantarflexion of the first ray. Sagittal plane correction
MDCO procedure
Slide the posterior aspect of the calcaneus medially to create more a varus force from the ground. Frontal plane correction
Miller arthrodesis
Fusion of the naviculocuneiform joints, also fusion of 1st metatarsal cuneiform (Lapidus)
Hoke arthrodesis
Fusion of the navicular and first 2 cuneiform joints
Triple arthrodesis
Fusion of the STJ, TN, and CC joints
Pantalar arthrodesis
Fusion of the ankle, STJ, and midtarsal joints
Stage 1 conservative treatment
Short leg cast or walking boot 4-6 weeks
PT
Anti-inflammatory
Orthotics
Stage 2 A conservative treatment
Typically orthotics with a deep heel cup
Stage 2 B conservative treatment
Typically orthotics with a deep heel cup, UCBL, extended medial counter or medial heel wedge
Stage 3 conservative treatment
Custom AFO, supramalleolar brace, allow AJ ROM
Stage 4 conservative treatment
Non-articulated AFO
Stage 1 surgery
Synovectomy
Stage 2 A surgery
Synovectomy Debridement Direct tendon repair Tendon Transfer Osteotomy Posterior muscle lengthening
Stage 2 B surgery
Synovectomy
Tendon transfer
Osteotomy and/or Arthrodesis
Arthroeresis
Stage 3 surgery
Typically arthrodesis and lengthening of the posterior muscle group
Stage 4 surgery
This typically involves the AJ, so it will require arthrodesis and deltoid ligament repair.
MDCO is sometimes required when valgus ankle deformity without DJD
Total ankle replacement or supramalleolar osteotomy
