Rigid Flatfoot Flashcards
What are the two primary etiologies of rigid flatfoot
Congenital Vertical Talus
Tarsal Coalition
How do you differentiate between rigid and flexible flatfoot?
Loss of Hindfoot/Midfoot Motion (STJ and MTJ)
How do you test for flexible versus rigid flatfoot?
Rigid flatfoot = Negative Hubscher Maneuver
Congenital Vertical Talus Appearance?
- Rigid Flatfoot w/ Rocker-bottom Appearance
- “Persian Slipper” Appearance
- 50% Associated with Neuromuscular or Genetic Condition
Congenital Vertical Talus Radiographic Findings
- Dislocated TNJ
- Talus severely plantarflexed - increased Talar-1st metatarsal angle
- Navicular dorsal on talus
- calcaneus in rigid equinus
- hindfoot in valgus
- Achilles tendon tight
Conservative Treatment for Congenital Vertical Talus
Reverse Ponseti - serial manipulation and casting
Minimally Invasive Treatment for Congenital Vertical Talus
Dobbs Method - Minimally invasive reduction and k-wire fixation of TNJ, percutaneous Achilles Tenotomy
Invasive Treatment for Congenital Vertical Talus
Open surgical releases and/or arthodeses
Primary Congenital Etiology of Tarsal Coalition
Failure of differentiation/segmentation of primitive mesenchyme - ie failure of bones to separate during the developmental process
- Autosomal dominant
Most common coalitions?
TC/CN —> 90%
Talocalcaneal
Calcaneonavicular
Clinical findings of a coalition
Asymptomatic
Pain
Limited motion
Muscle Spasm
What type of x-rays are ordered for a TC Coalition?
- Lateral
- Harris and Beath
Wha d o you see on a lateral x-ray of a TC coalition?
- Talonavicular Beaking
- “Halo” sign
- Flattening of lateral process of the talus
- Loss of STJ clarity
Best view for a CN Coalition
Oblique view
- otter views are lateral and DP
What is the “sign” used to describe CN Coalition
Comma sign on oblique view
Anteater sign on lateral view
Which Coalition mimics pseudoarthrosis?
CN Coalition
Based on patient’s age, who should be given arthroplasty vs arthrodesis
Juvenile - Arthroplasty
Adult - Arthrodesis
What are the two extra-articular coalitions?
- Calcaneonavicular
- Cubonavicular
What are the intra-articulate coalitions
- Talocalcaneal
- Talonavicular
- Calcaneocuboid
- Naviculocuneiform
Match arthroplasty and arthrodesis to extra-articular and intra-articular involvement
Extra-articular - arthroplasty
Intra-articular - arthrodesis
List some characteristics of secondary arthritic changes
- Joint beaking
- loss of joint clarity
- joint irregularity/adaption
Is arthroplasty or arthrodesis preferred for secondary arthritic changes?
Secondary arthritic changes - arthrodesis
No secondary arthritic changes - arthroplasty
Peroneal spastic flatfoot without tarsal coalition can be caused by a rare condition called
accessory aneterolateral Tamar facet (AALTF) - restricts the motion of the STJ causing peroneal spasm
How does intraarticular coalition size affect treatment plan?
Less than 50% joint involvement - arthroplasty
More than 50% joint involvement - arthrodesis
What is the procedure for an extra-articulation Calcaneonavicular coalition
Badgley procedure aka EDB arthroplasty
What is the preferred surgical technique method for an intra-articulated arthroplasty?
Direct medial approach
- take the TP/FDL tendons dorsally
- take the NV bundle/FHL plantarly
- resect the coalition
when would you do a single arthrodesis?
- intra-articular coalition
- No secondary arthritis
When would you do a triple arthrodesis?
- secondary arthritis
On MRI what sign do you see for a calcaneonavicular coalition
Reverse anteater sign
On MRI what sign do you see for a talocalcaneal coalition
Drunken Waiter sign
