Rearfoot EBM

Question 1

When determining planal dominance in a flatfoot, what radiographic abnormalities would you expect to see in a sagittal plane deformity?

Answer 1

1. decreased calcaneal inclination angle
2. increased talar declination angle
3. increased Meary’s angle (talometatarsal angle)
4. naviculo-cuneiform breach

Question 2

When determining planal dominance in a flatfoot, what radiographic abnormalities would you expect to see in a frontal plane deformity?

Answer 2

1. widening of the lesser tarsal area on AP view
   2, decrease in 1st met declination angle
2. decrease in height of sustentaculum tali
3. increase in the superimposition of lesser tarsal area on lateral view

Question 3

When determining planal dominance in a flatfoot, what radiographic abnormalities would you expect to see in a transverse plane deformity?

Answer 3

1. increased Kite’s angle (talocalcaneal angle)
2. increased cuboid abduction angle
3. increased talar head uncoverage (or decrease in % of TN congruency)

Question 4

What orthotic modifications would you consider prescribing for a flatfoot?

Answer 4

medial heel skive
RF varus post
deeper heel cup
medial flange

Question 5

What surgical procedure would you consider for a sagittal plane deformity (i.e. sagging of medial column)?

Answer 5

soft tissue- Young’s tenosuspension

Osseous- Miller, Hoke, Lapidus, cotton

Question 6

What surgical procedure(s) would you consider for a transverse plane deformity?

Answer 6

Evans

Question 7

What surgical procedure(s) would you consider for a frontal plane deformity?

Answer 7

PCDO

arthroereisis

Question 8

What is a cotton procedure?

Answer 8

(for flexible dorsiflexed 1st ray)

dorsal opening wedge in the medial cuneiform to help plantarflex the medial column

Question 9

What radiographic angles are used to evaluate the apex of deformity in a pes cavus foot?

Answer 9

Hibbs angle
Meary’s angle
*the intersection of each tells you the apex of deformity

Question 10

what is the normal calcaneal inclination angle?

Answer 10

18-21 deg

Question 11

What does the STATT procedure accomplish?

Answer 11

(for cavus foot)
effectively makes the TA a more neutral dorsiflexor by balancing its power laterally (rather than having a net supinatory effect)

Question 12

What is the indication of a Dwyer? Describe this procedure.

Answer 12

(rigid RF varus)

lateral closing wedge osteotomy of the posterior calcaneus

Question 13

How does Hibbs angle change in a pes cavus deformity?

Answer 13

deceases . 150)

Question 14

what is considered increased calcaneal inclination angle for a pes cavus deformity?

Answer 14

> 30 deg

Question 15

what is normal Kite’s angle?

Answer 15

ages 0-5:35-50 deg

age 5-adult: 15-21 deg

Question 16

what is normal Meary’s angle?

Answer 16

0-10 deg

Question 17

describe the cobb procedure.

Answer 17

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

Question 18

describe the Young tenosuspension.

Answer 18

TA is re-routed thru a keyhole in the navicular

*used to correct TN or cuneonavicular fault in a flexible flatfoot

Question 19

Describe the Kidner procedure.

Answer 19

Resection of navicular tuberosity followed by transposition of the insertion of tibialis posterior tendon plantarly into the under-side of the navicular

Question 20

What is normal tib-fib overlap?

Answer 20

overlap >10mm

Question 21

What is the normal tib-fib clear space?

Answer 21

tib-fib clear space >6mm

Question 22

how much is normal medial clear space?

Answer 22

> = 4mm

*just make sure to have even clear space all the way around the joint

Question 23

what is normal talar tilt?

Question 24

what type of fractures are associated with ankle sprains?

Answer 24

ankle fx
Maisonneauve fx
anterior process calc fx 
posterior talus fx 
os peroneum
Tillaux fx (Salter-harris 3)

Question 25

What osseous procedure could you do to correct a cavus foot with a primarily frontal plane deformity?

Answer 25

DFWO of the 1st met
Dwyer
lateral calcaneal slide

Question 26

What osseous sagittal could you do to correct a cavus foot primarily frontal plane deformity?

Answer 26

tarsal osteotomies: Cole, Japas, Jahss

arthrodesis: IPJ, MTJ, TMTJ

Question 27

what osseous procedure(s) could you do to correct a cavus foot with a primarily transverse plane deformity?

Answer 27

TMTJ fusion

Question 28

what osseous procedures could you do to correct a flatfoot with primarily a transverse plane deformity?

Answer 28

(lateral column lengthening osteotomies)
Evans
CCJ distraction arthrodesis

Question 29

What osseous procedures could you do to correct a flatfoot with primarily frontal plane deformity?

Answer 29

PCDO/ medial calcaneal slide

reverse dwyer

Question 30

what osseous procedures could you to do to correct a flatfoot with primarily sagittal plane deformity?

Answer 30

(medial column stabilization procedures) 
Cotton 
Miller arthrodesis
Hoke arthrodesis
Lowman arthrodesis

Question 31

describe the Cole procedure.

Answer 31

(used to correct a sagittal plane deformity in a cavus foot) dorsiflexory wedge is removed from Chopart’s joint

Question 32

describe the Hibbs tenosuspension procedure.

Answer 32

(used to correct extensor substitution hammertoes)
EDL tendons are detached distally and transferred to the lateral cuneiform or base of 3rd met & fusion of lesser toes is performed