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83 Cards in this Set
- Front
- Back
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What is the range of normal values for the talocalcaneal angle on lateral film?
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35 to 50 degrees
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What is the range of normal values for the talocalcaneal angle on AP (Kite‘s angle) film?
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20 to 40 degrees
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What gender is most commonly affected?
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Male
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How often does bilateral involvement occur?
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50%
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What is Streeter’s dysplasia?
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Clubfoot with associated hand anomalies
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lf a clubfoot is seen on prenatal ultrasound, what is the next step?
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Amniocentesis to evaluate for other abnormalities
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What are the two key features of the forefoot position?
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Adducted
Supinated |
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What are the two key features of the hindfoot position?
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Equinus
Varus |
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What is the key classic radiographic feature?
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Talocalcaneal parallelism
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What is the talocalcaneal angle on dorsiflexion lateral film?
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<35 degrees
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What is the talocalcaneal angle on AP film?
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<20 degrees
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Nonoperative treatment: What is the acronym for order of the four steps in deformity correction?
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Acronym CAVE:
Cavus Adductus Varus Equinus |
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How long should a Ponsetti cast be?
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A long leg cast
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At which anatomic location should corrective pressure be applied?
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Lateral talar head
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After casting has been completed, how can the correction be maintained?
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Dennis-Browne bars
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80% of clubfoot patients ultimately require what adjunctive procedure?
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Achilles lengthening
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25% of those patients also require what procedure?
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Lateral transfer of tibialis anterior
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How long should cast treatment be attempted before operating on a
resistant clubfoot? |
6 to 9 months
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What artery is most commonly insuffcient with clubfoot?
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Dorsalis pedis
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If a child presents late (8 to 10 years old) with clubfoot, what is the preferred surgical option?
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Triple arthrodesis
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A triple arthrodesis is contraindicated in what situation?
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lnsensate feet
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What is a better option for insensate patients?
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Talectomy
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What systemic disorder is associated with bilateral skewfeet?
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Diastrophic dysplasia
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What is the key feature of the position of the TMT joint?
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Adduction
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What is the key feature of the talonavicular position?
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Lateral subluxation
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What is the key feature of the hindfoot position?
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Valgus
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How is skewfoot treated?
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Operative intervention
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What is the hindfoot position in vertical talus?
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Equinus
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What is the forefoot position?
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Abducted
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Bottom line: A foot with a vertical talus is essentially what?
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Rigid flatfoot
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What are the key radiographic features on a plantar flexion lateral film?
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Tarsometatarsal angle >2O degrees
Talocalcaneal angle >5O degrees |
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What is the key radiographic feature on an AP film?
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Talocalcaneal angle >40 degrees
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How can vertical talus and oblique talus be distinguished?
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Oblique talus corrects with plantar flexion
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What is the first step in the treatment of vertical talus?
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Casting for the first 3 months
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At what age is surgery undertaken?
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6 to 12 months of age
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Surgical intervention must include what?
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Extensive soft tissue release
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lf vertical talus recurs, what procedure has been historically favored as the next step?
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Subtalar arthrodesis
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What if the foot is insensate?
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Talectomy
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More recently, what have the two first-line procedures been?
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Dorsal talonavicular
approach (talonavicular fusion) Tendo-Achilles lengthening |
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lf vertical talus recurs, what procedure is currently favored as the next step?
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Naviculectomy
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How is oblique talus treated?
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UCBL (University of California Biomechanics Laboratory) orthosis
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With clubfoot, what is the hindfoot position?
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Varus
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the talonavicular joint position?
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Medial dislocation
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. . . the forefoot position?
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Adducted
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With metatarsus adductus, what is the hindfoot position?
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Neutral
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. . . the talonavicular joint position?
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Neutral
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. . . the forefoot position?
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Adducted
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With vertical talus, what is the hindfoot position?
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Valgus
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. . . the talonavicular joint position?
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Dorsal dislocation
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. . . the forefoot position?
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Abducted
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With skewfoot, what is the hindfoot position?
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Valgus
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. . . the talonavicular joint position?
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Lateral dislocation
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. . . the forefoot position?
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Adducted
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What is the inheritance?
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AD
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Tarsal coalition is also referred to as what?
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Peroneal spastic fiatfoot
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What are the two most common sites of coalition?
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Calcaneonavicular
Subtalar |
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What site is more common in children who present between ages 10 and 12?
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Calcaneonavicular
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What site more common in ages 12 to 14?
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Subtalar
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What is the best imaging modality for diagnosis of a coalition?
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Computed tomography (CT)
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What is the initial treatment for all coalitions?
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Casting, orthotics
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What is the treatment for a resistant calcaneonavicular
coalition? |
Resection alone is usually adequate
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What is the preferred surgical approach?
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Lateral
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With subtalar coalition: the coalition is in the __ facet, but must also check the ___ facet.
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Coalition in the middle facet
Must also check the posterior facet |
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What three factors are poorly prognostic in patients with subtalar coalition?
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Coalition involves >50% of middle facet
Heel valgus >21 degrees Posterior facet narrowing |
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Surgical treatment: what is the general rule of thumb?
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<50% middle facet involved:
< or equal to 50% middle facet involved: fuse |
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What is the preferred surgical approach?
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Medial
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If this fails, what is the next procedure?
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Triple arthrodesis
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Bottom line: What is the treatment for hindfoot abnormalities identified late, with arthritis, or after failed initial surgery?
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Triple arthrodesis .
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Triple arthrodesis is contraindicated in what patients?
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Those with insensate feet
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What is pes planovalgus due to?
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Ligamentous laxity
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In comparison, what is the usual etiology of flatfeet in adults?
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Posterior tibial tendon dysfunction
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What is the hindfoot position?
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Valgus
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What is the forefoot position?
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Supinated
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What is the symptomatic association between flexible flatfeet and tight Achilles tendons?
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Patients with tight Achilles are especially likely to develop symptoms
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Radiographic features: what is Meary’s line?
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Talus-first metatarsal angle plantar sag (talus "points"
plantarly) |
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ls surgery necessary?
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Very rarely
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Surgical treatment includes what two procedures?
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Calcaneal osteotomy
Posterior tibial tendon advancement |
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What procedure is not included for flexible flatfoot treatment?
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Subtalar arthrodesis
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What population is particularly at risk for calcaneovalgus feet?
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First-born children
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What is the foot deformity clue to?
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lntrauterine position
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What is the preferred treatment?
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Passive stretching
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What other condition must be excluded in patients with calcaneovalgus feet?
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1.5 myelomeningocele
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What is the associated direction of tibial bow?
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Posteromedial (physiologic)
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