Hershey Manual Ch 21; Surgery Of The Congenital Foot

Front 1

List the possible etiologies of pes planovalgus (flat foot)

Back 1

-Downs, Ehlers Danlos, Marfans, Morquios
-calcaneovalgus (not all cases)
-biomechanical (FF varus, FF valgus, equinus, tosional abnormalities, muscle imbalance-weak supinators, lig laxity, neurotrophic feet, enlarged navicular, LLD

Front 2

the STJ axis is 42 from the transverse and 16 from the sagittal, any change in this will result in changes to motion on the various planes. how does the dominant plane of deformity (checked on clinical exam) relate to the position of the joint axis

Back 2

-if frontal plane motion (inv/evr) is dominant, the joint axis will be more horizontal
-if transverse plane motion (ab/ad) is dominant, the joint axis is more vertical
-if sagittal is dominant, the joint axis lies closer to the frontal and horizontal planes

Front 3

List the xray characteristics of transverse plane dominant flat foot

Back 3

--inc in AP TC angle
-inc in cuboid abduction angle
-dec in TN congruency

Front 4

List the xray characteristics of frontal plane dominant flat foot

Back 4

-widening of lesser tarsus on AP
-dec in 1st met dec angle
-dec in sus tali height

Front 5

List the xray characteristics of sagittal plane dominant flat foot

Back 5

-inc in talar dec
-navi-cune breech
-dec CI

Front 6

Harris Beath views are helpful in determining TC coalitions; what are the angles

Back 6

-taken from posterior and superior with the xray beam at 35, 40, 45 to the perpendicular
-middle and posterior facets can be visualized (middle is smaller)
-an angualtion of middle facet of more than 20 degrees from vertical can sugget a coaltion even if joint space is visualized

Front 7

which planal flat foot is most difficult to treat non surgically

Back 7

transverse plane motion

Front 8

what muscle does Kidner procedure change the leverage of

Back 8

TP tendon
-inserts the TP tendon under the navicular

Front 9

list the parts of the Lowman procedure

Back 9

1. TAL
2. TN wedge fusion
3. reroute the TA under the navi and suture it to spring ligament
4. fold down a slip of achilles to augment the medial arach (since it is still attached to the calc, it maintains FF in adduction)

Front 10

Rerouteing, w/o detaching the TA tendon through a slot in the navi

Back 10

Youngs tendon transposition
-also reattaches the TP tendon, but under side of the navi

Front 11

also see Flat foot flashcards

Back 11

.

Front 12

TAL, navi to medial cune fusion, used with NC sag and pts whose bone growth is compelte with secondary joint changes

Back 12

Hoke arthrodesis

Front 13

pes planus procedure that blocks all MTJ motion and most STJ motion (90%)

Back 13

TN arthrodesis
-used wtih DJD/sever collapse at TNJ, paralytic deformity, ruptured TP

Front 14

good boney procedure when the forefoot abducts severly when the STJ is neutral

Back 14

Evans
-lateral column is lengthened, entire foot is forced to pivot around the head of the talus, effectively adducting the forefoot and tightening the medial arch, and reducing heel valgus

Front 15

what will happen if an Evans is performed and excess lengthening of the lateral column occurs

Back 15

-equinus may be produced
-talus abducts and dorsiflexes

Front 16

Posterior calcaneal osteotomies for flatfoot are most useful is the least prevalent type of flat foot..which is?
(GLeich, Dwyer, Silver, Kouts)

Back 16

-frontal plane dominance
-most useful in conjuction with medial column procedures

Front 17

with a Kouts, how far medially is the posterior fragment translated

Back 17

-to underneath the sus tali

Front 18

what soft tissue procedure is indicated in almost all flat foot cases

Back 18

TAL

Front 19

what are some objections to arthrooresis in flat foot

Back 19

-fusion of one portion of STJ can cause DJD of other joints
-no FF correction occurs, which is usually in cavus
-potential for failure of screw
-LT loss of correction

Front 20

list indications for triple AD (STJ, CC, TN)

Back 20

-valgus foot
-colapsing pes valgus
-ruptured TP
-tarsal coalitions
-tarsal DJD
-cavus
-TEV

Front 21

why is the MTJ (CC, TN) resected first in a triple

Back 21

-easier to manipulate the foot

Front 22

which joint is fixated first in a triple

Back 22

-STJ

Front 23

what is the advantage of a Grice-Green (EASTA- extra articular STJ arthrodesis)

Back 23

-allows you to fuse the STJ without disturbing growth

Front 24

list criteria a pt must meet for an arthroeresis

Back 24

-age 4-8
-cavovalgus foot
-at least 8 degrees heel eversion
-dominant frontal plane
-flexible FF varus above 10 degrees

Front 25

surgical tx for MA, that is flexible and reducible on stress xrays, child is less than 5 yo

Back 25

-Soft tissue procedure (Heyman-Herndon-Strong)
-release of dorsal, interossei and plantar ligaments of tarsomet joints and intermet joints

Front 26

sx tx for MA age 5-8 yrs

Back 26

-Cartilaginous procedure (Johnson osteochondrotomy)
-closing abducotry wedge base 1st met
-wedge resection of cartilage from bases of lesser mets, fix with pins

Front 27

sx tx for MA in older child (6-8 yo)

Back 27

-Berman Gartland
-closing abductory wedges in all mets, fix with wires, staples etc

Front 28

sx tx for MA in child >8 yo

Back 28

-Lepird (like a Weil, but at the bases)
-Juvara of 1st met
-rotational osteotomy of lesser mets with fixation

Front 29

what is the V test for MA

Back 29

-place the foot between the pointer and middle finger, FF deviates away from the middle finger with positive MA

Front 30

what is the progression of Cavus foot deformity as the pt ages

Back 30

-goes from flexible deformity to a rigid deformity

Front 31

what type of HT are present in cavus foot

Back 31

-Extensor substitution
-with a weak TA, the extensors substitute for ankle DF causing hyperextension of MPJ and retrograde pressure on the met heads

Front 32

what causes the varus heel in cavus foot

Back 32

-weak PB and strong TP

Front 33

what causes development of calw toes in cavus foot

Back 33

-paralysis of intrinsics
-also weak gastroc can cause flexor subs and clawtoes

Front 34

Steindler stripping and serial casting can be used for flexible cavus deformity.. describe

Back 34

-abductor hallucis
-FDB
-abductor digiti quinti
-plantar fascia
-the long plantar ligament (long calcaneocuboid ligament; superficial long plantar ligament) is a long ligament on the underside of the foot that connects the calcaneus with the cuboid bone. creates a tunnel on Cuboid for the PL

Front 35

complictions of steindler stripping

Back 35

-plantar fascitis
-forefoot may be splayed

Front 36

when are tendon transfers best used for Cavus tx

Back 36

-less than 10 years old
-if 1st ray is PF and flexible - Jones suspension
-other tendon releases and transfers are plausible, just focus on what type of cavus and where the deformity is located

Front 37

what is a Heyman procedure for flexible cavus

Back 37

-transfer all 5 extensor tendons to their respective met heads
-Jones (only the EDL to the neck of the 1st met with IPJ AD)

Front 38

Hibbs procedure can be used for flexible anterior cavus

Back 38

-transfer of long extensors to 2nd/3rd cuneiform with a Jones

Front 39

procedure for fixed (rigid) anterior cavus

Back 39

Cole
-cuboid to NC joint wedge
-creates a shorter, wider foot
Japas
-midtarsal V osteotomy
-apex proximal
(at the apex of the cavus)
-lateral limb through cuboid
-medial limb through cunei

Front 40

what is the difference in uses for the Cole and Japas

Back 40

-Cole is for more severe deformities and only for hte skelatally mature foot

Front 41

general idea for Cavus correction

Back 41

-try ST releases and tendon transfers for flexible deformity
-address the specific deformities (ex if PF ray, DF it...if calc varus, do a heel procedure)

Front 42

what soft tissue is the deforming force on the medial side of the foot in clubfoot (TEV)

Back 42

-master knot of henry
-must be severed to allow the navi to move back laterally

Front 43

where is the bisection of the talus on AP view for clubfoot (with relation to the first met)

Back 43

-lateral to the 1st met

Front 44

what is kites angle (AP view) with clubfoot

Back 44

TC angle (Kites) approaches zero (N=20-40)

Front 45

what is the relationship between the talus and calcaneus in the clubfoot

Back 45

-they are paralell

Front 46

general order of sx correction for clubfoot

Back 46

-posterior medial release
-plantar release
-subtalar release
-met adductus procedure
-tendon transfers
-calc osteotomies
-triple AD with ST releases
-amputation if all else fails

Front 47

when should you consider Soft tissue surgery for clubfoot

Back 47

-after 3 months of failed conservative care
-Posterior Medial Subtalar release (Turco procedure)
-Turco believed this was best at age 1-2 yo
-good results dec with age
-good results if child is walking due to Wolf's law to help bone remodel

Front 48

when is osseous sx tx used in clubfoot correction

Back 48

-at 4 years of age or if soft tissue surgery failed

Front 49

List osseous surgical tx for clubfoot

Back 49

-Evans
-Dwyer
-triple
-talectomy if foot is severely deformed

Front 50

Mann recipe for flat foot

Back 50

Evans
Kouts
Cotton
Gastroc

Front 51

TC angle on lateral and AP

Back 51

AP 25
Lateral 40

Front 52

what should be the first step in clubfoot correction

Back 52

replacement of the navi on the talus (talus is lateral to where it should be)