Surgical Procedures Of The Foot And Ankle Flashcards
What procedures are commonly used to correct Hallux Valgus?
Akin Osteotomy
Chevron Osteotomy
Scarf Osteotomy
Basal Metatarsal Osteotomy (Opening Wedge)
Lapidus Procedure
What procedures are commonly used to treat hallux rigidus?
1st MTPJ Arthrodesis (Gold standard for hallux Rigidus)
Cheilectomy
Keller’s Excision Arthroplasty
1st MTPJ Replacement/ Total Arthroplasty
1st MTPJ Interpositional Arthroplasty
What procedure can be used to treat clawing of the hallux?
Jones’ Procedure - Arthrodesis of 1st IPJ with tendon transfer for EDL
What procedure is used to treat severe HAV deformities, 1st ray hyper-mobility and 1st ray arthritis?
Lapidus Procedure - 1st TMTJ arthrodesis with rebalancing of distal soft tissues
What osteotomy can be used to treat hallux valgus interphalangeus?
Akin Osteotomy - Closing wedge phalangeal osteotomy
What are the three key aspects of a scarf osteotomy?
Z-Shaped osteotomy of the metatarsal shaft
Lateral soft tissue release
Shaving of the prominent medial eminence
What are the indications for a talo-navicular or STJ arthrodesis?
Talo-Navicular Arthritis
STJ Arthritis
What is a triple arthrodesis?
Arthrodesis of the STJ, talo-navicular joint and calcaneo-cuboidal joint
What are the indications for a triple arthrodesis?
The main indications for triple arthrodesis fall under the categories of: ARTHRITIS, INSTABILITY, DEFORMITY
ARTHRITIS:
- Painful degenerative or post-traumatic arthritis of the Hindfoot
- Charcot arthropathy affecting the Hindfoot
- Inflammatory arthritis affecting the Hindfoot
INSTABILITY:
- A-propulsive and unstable gait caused by neuromuscular conditions such as poliomyelitis and cerebral palsy
DEFORMITY:
- Severe pes planus or pes planovalgus deformity with loss/weakness of adjacent soft tissue structures and adaptive changes of surrounding joints (Can be caused by end stage TPTD)
- Longstanding cavovarus deformity (often caused by neuromuscular disorders such as poliomyelitis, ALS, HMSN, and in early stages can be treated with tendon lengthening or transfers)
- Longstanding hindfoot varus or valgus deformities
- Equinovarus deformities, causing joint degeneration or an a-propulsive gait
Often the presence of arthritis or progressive neuromuscular pathologies can lead to joint degeneration and weakness of the surrounding soft tissue structures, which leads to instability and eventually causes rigid deformities. So all three aspects feed into one another and result in the need for a triple arthrodesis.
What are the indications for a talo-crual joint arthrodesis?
Severe ankle arthritis
Failed ankle joint replacement
What procedures can be used to treat Hindfoot deformities and arthritis?
Calcaneal Osteotomies:
- Translational Osteotomies
- Evan’s Osteotomy - lateral column lengthening osteotomy
- Dwyer’s Osteotomy - lateral closing wedge osteotomy
- Scarf Osteotomy
Joint Arthrodesis:
- TNJ
- STJ
- Triple
- Talo-crual
Talo-crual Joint Arthroplasty
-Total
- Hemiarthroplasty
What is a cotton osteotomy?
A dorsal opening wedge osteotomy of the medial cuneiform
What are the indications for a cotton osteotomy?
Pes Planovalgus and Pes Planus deformities
Surgical correction of stage 2 tibialis posterior tendon dysfunction deformity
Forefoot Varus deformities (as a result of congenital flatfoot)
Overcorrected talipes equinovarus (clubfoot)
Tarsal coalition
Outline the 6 factors of an ideal metatarsal osteotomy?
Easy to perform
Stability
Good healing potential
No shortening
Minimises the risk of avascular necrosis
Metatarsal head is not elevated after procedure
What are the benefits of a scarf osteotomy?
As it involves cutting the bone into dorsal and plantar fragments…
Large displacement is possible - so it can correct more severe deformities
It creates large contact surfaces - allowing for good bone healing and union
Good and stable internal fixation is possible
What is the main disadvantage of a Mitchell osteotomy?
A Mitchell osteotomy is a distal osteotomy, involving shortening of the 1st metatarsal bone. The main disadvantage of this procedure and any shortening metatarsal osteotomy is the risk of transfer metatarsalgia (Excessive load transferred onto the lesser metatarsal heads and TMTJs due to dysfunction of the 1st ray, causing pain)
What surgical procedure is used to treat mild HAV (with an intermetatarsal angle up to 14°) ?
Chevron Osteotomy - Distal osteotomy of the 1st metatarsal bone
A rotational biplanar chevron osteotomy can be used to correct mild HAV when the distal articular metatarsal angle is increased
What surgical procedure is used to treat moderate HAV (with an IMA between 14-20°)?
Scarf Osteotomy with distal soft tissue rebalancing + Akin osteotomy of the proximal 1st phalanx if hallux interphalangeus is present
What are the 5 surgical procedures that can be used to correct severe HAV (with an IMA < 20°)?
Scarf Osteotomy - Generally preferred option
Rotational Ludoff or Chevron Osteotomy
1st MTPJ Arthrodesis
Proximal (basal) opening or closing wedge osteotomy
1st TMTJ Arthrodesis/ Lapidus Procedure
What procedure is used to treat hallux valgus with 1st TMTJ hyper-mobility
Lapidus Procedure
What procedure is used to treat hallux valgus with 1st MTPJ degeneration/ arthritis?
1st MTPJ Arthrodesis
What is the difference between an incongruent and a congruent HAV deformity?
Congruent HAV - The articular surfaces of the 1st metatarsal and 1st proximal phalanx are in maximum contact with each other, and the distal metatarsal articular angle (DMAA) is increased (>10°) but the intermetatarsal angle (IMA) is normal (<9°). This is not common in severe HAV but can occur in mild or moderate HAV.
Incongruent HAV - The 1st proximal phalanx is laterally subluxed, so the DMAA is normal (<10°) but the hallux valgus angle is increased (>15°) as is the IMA (>9°). This is common in moderate to severe HAV deformities
What procedure is commonly indicated for treatment of a flexible flat-foot deformity?
A lateral column lengthening calcaneal osteotomy (Modified Evan’s opening wedge osteotomy)
What conditions that can be treated through surgery are associated with the term ‘metatarsalgia’?
PDN
Sesamoiditis
Synovitis of the lesser MTPJs
MTPJ dislocations + Plantar plate tears
Freiburg’s Disease
Bunionette/ Tailor’s Bunion
Metatarsal stress fractures
