Surgery of foot Flashcards
Natural hindfoot appearance
Natural foot valgus
- Hindfoot lateral placed
IF this is more valgus, the mid and forefoot compensate= flat foot.
Achilles tendon (tendo calcaneous)
Tendon for that arises from:
- Soleous
- Gastrocnemius
- Plantaris (if present)
Inserts into calcaneus
Function= plantar flexion of foot
Achilles tendon vulnerability
No tendon sheath
- Contains paratenon instead
Poor blood supply
- Posterior tibial artery= proximal and distal
- Peroneal artery= midsection
Vascularity Is weakest where it attaches to bone
- 2-6cm from attachment (more likely to tear hear)
Achilles tendon rupture
- Cause
- Location of tear
Cause
- Sudden plantar flexion
- Violent dorsiflexion in plantar-flexed foot
Location: in hypovascular region
- 4-6cm above calcaneous insertion
Achilles tendon rupture
- Treatment
Non-surgical
- Functional bracing
Surgical
- End to end repair
- VY advancement
- Tendon transfer if others fail
Achilles tendon rupture surgical approach
Position
- Prone/ lateral
Landmarks
- Malleoli
Incision
- Longitudinal
Structure to avoid
- Sural nerve laterally
- Medial to flexor halluces longus= neurovascular bundle
Tibialis posterior tendon
- Origin and insertion
- Action
- Blood supply
- Innervation
Origin
- Posterior interosseous membrane
- Fibula,tibia
Insertion
- Navicular
- Medial cuneiform
Action
- Plantar flexion
- Inversion of foot
- Adduction and supination
- supports medial arch
Arterial supply
- Posterior tibial
Innervation
- Sural
- Tibial
Tibialis posterior insufficiency
- Signs and symptoms
Posterior malleolar pain
Medial arch pain/ache
Flat foot
Rare- tarsal tunnel
Progressive valgus, lesser toes deformity
Tibialis posterior insufficiency
- Treatment
Non-surgical treatment
- Analgesics
- Shoe wear modification
- Orthotics to support medial arch
- Physio
Surgery
- Tendon transfer
- Fusion (if secondary to arthritis)
Tendon transfer for Tibialis posterior insufficiency
Uses flexor halluces longus
Avoid:
- Long saphaneous vein and nerve
Surgical Management of Ankle Arthritis
- Early
- Later
Early= preserve joint
- Debridment/ synovectomy
Late= joint fusion/ replacement
- Arthrodesis (fusion)
- Arthroplasty (replacement)
- Excision arthroplasty (excision of joint)
Ankle arthroplasty
Ankle replacement
Allows;
- Pain relief
- Preservation of joint mobility
- Preserves function
Dangers in surgery
- Superficial peroneal
- Deep peroneal
- Anterior tibial artery
Ankle arthrodises
Fusion of joint
Allows:
- Pain relief for when replacement is not appropiate
Tibiotalocalcaneal arthrodesis
Fusion of tibiotalar and talocalcaneus joint
Indication
- Severe deformity
- Osteoporotic ankle fracture
- Failed ankle fixation
- Failed TAR
Ankle sprain
Tear/ Stressed ligament
Usually lateral ligament
- Anterior talofibular (weakest)
- Calcaneofibular (weakest0
- Posterior talofibular
