planovalgus

Question 1

causes of planovalgus in adults and children?

Answer 1

Acquired:
- tib post insufficiency
- trauma - lis franc, spring ligament injury
- degenerative - OA, charcot
- inflammatory - RA

Congenital:
- neuromuscular - CP
- collagen disorders - Marfans
- tarsal coalition
- Down’s syndrome

degenerative and tib post dysfunction most common in adults

Question 2

risk factors for tib post insufficiency?

Answer 2

• obesity
• diabetes
• age
• steroids
• inflammatory

Question 3

johnston and strom classification

Answer 3

Stage I - tendinopathy
* single heel raise
* tendinopathy
* no deformity

Stage 2 - flexible deformity
* valgus and arch collapse
* tendon attenuated and dysfunctional
* too many toes
* no heel raise

Stage 3 - rigid deformity
* rigid
* no heel raise
* degenerate subtalar joint

Stage 4 - rigid deformity and arthritic changes
- rigid
- no heel raise
- loss of deltoid ligament
- talar tilt

Question 4

Pes planus management

Answer 4

Stage I
- orthotics - heel cup and medial posting
- physio
- tendon debridment

Stage II
- Orthotics and physio
- FDL transfer to tib post tendon
- Calcaneal medial displacement osteotomy
- Spring ligament repair
- Lateral column lengthening - forefoot abduction
- Cotton medial cuneiform dorsal opening wedge osteotomy - fixed forefoot supination
- Gastroc/ TA lengthening

Stage III
- triple arthrodesis

Stage IV
- tibiotalarcalcaneal fusion/ ankle arthrodesis/ replacement

Calcaneal medial displacement osteotomy
- reduces joint reaction forces across ankle and subtalar joint and moves achilles medially

FDL transfer
- FDL directly posterior to tib post
- harvest knot of henry
- excise disease tib post tendon
- drill hole navicular and pass tendon through and suture back on itself correct tension

after FDL transfer - FHL responsible for toe flexion due to fibrous connections between the two tendons at the knot of henry

Question 5

how do you perform a triple arthrodesis?

Answer 5

• subtalar
• talonavicular
• calcaneocuboid joints

Lateral approach
- base of 4th MT to post tip of fibular
- through EDB
- calcaneocuboid and subtalar joints

Anterior approach
- inline with tib ant
- level of talonavicular joint
- retract tib ant and NV bundle