Rearfoot EBM Flashcards
When determining planal dominance in a flatfoot, what radiographic abnormalities would you expect to see in a sagittal plane deformity?
- decreased calcaneal inclination angle
- increased talar declination angle
- increased Meary’s angle (talometatarsal angle)
- naviculo-cuneiform breach
When determining planal dominance in a flatfoot, what radiographic abnormalities would you expect to see in a frontal plane deformity?
- widening of the lesser tarsal area on AP view
2, decrease in 1st met declination angle - decrease in height of sustentaculum tali
- increase in the superimposition of lesser tarsal area on lateral view
When determining planal dominance in a flatfoot, what radiographic abnormalities would you expect to see in a transverse plane deformity?
- increased Kite’s angle (talocalcaneal angle)
- increased cuboid abduction angle
- increased talar head uncoverage (or decrease in % of TN congruency)
What orthotic modifications would you consider prescribing for a flatfoot?
medial heel skive
RF varus post
deeper heel cup
medial flange
What surgical procedure would you consider for a sagittal plane deformity (i.e. sagging of medial column)?
soft tissue- Young’s tenosuspension
Osseous- Miller, Hoke, Lapidus, cotton
What surgical procedure(s) would you consider for a transverse plane deformity?
Evans
What surgical procedure(s) would you consider for a frontal plane deformity?
PCDO
arthroereisis
What is a cotton procedure?
(for flexible dorsiflexed 1st ray)
dorsal opening wedge in the medial cuneiform to help plantarflex the medial column
What radiographic angles are used to evaluate the apex of deformity in a pes cavus foot?
Hibbs angle
Meary’s angle
*the intersection of each tells you the apex of deformity
what is the normal calcaneal inclination angle?
18-21 deg
What does the STATT procedure accomplish?
(for cavus foot)
effectively makes the TA a more neutral dorsiflexor by balancing its power laterally (rather than having a net supinatory effect)
What is the indication of a Dwyer? Describe this procedure.
(rigid RF varus)
lateral closing wedge osteotomy of the posterior calcaneus
How does Hibbs angle change in a pes cavus deformity?
deceases . 150)
what is considered increased calcaneal inclination angle for a pes cavus deformity?
> 30 deg
what is normal Kite’s angle?
ages 0-5:35-50 deg
age 5-adult: 15-21 deg
what is normal Meary’s angle?
0-10 deg
describe the cobb procedure.
Medial half of the TA tendon is transferred thru a drill hole in the medial cuneiform or navicular , and a reconstruction of the TPT is performed
describe the Young tenosuspension.
TA is re-routed thru a keyhole in the navicular
*used to correct TN or cuneonavicular fault in a flexible flatfoot
Describe the Kidner procedure.
Resection of navicular tuberosity followed by transposition of the insertion of tibialis posterior tendon plantarly into the under-side of the navicular
What is normal tib-fib overlap?
overlap >10mm
What is the normal tib-fib clear space?
tib-fib clear space >6mm
how much is normal medial clear space?
> = 4mm
*just make sure to have even clear space all the way around the joint
what is normal talar tilt?
what type of fractures are associated with ankle sprains?
ankle fx Maisonneauve fx anterior process calc fx posterior talus fx os peroneum Tillaux fx (Salter-harris 3)
