Nbr - Cavus Foot

Front 1

Pes cavus is primarily a deformity in which body plane?

Back 1

saggital plane/

Front 2

How is pes cavus deformity classified?

Back 2

Pes cavus is classifed as anterio cavus, posterio cavus , or a comination
The deformity is further classifed as flexible (positional -reduces wiht weight bearing) or rigit (strucural does onto reuce wiht weigh bearing)
Anerior cavus can be furhter divied base on the apex of hte deformity - metarasal cavus (occuring at lisfran's oint) lesser tarsal cavus (occuring over lesser tarsal boens) forefoot cavus 9occuring at chopat's joint and combined anterior cavus (excessive paltarflexion occuring at two or more of hte areas mentind

Front 3

what does anterior cavus mean?

Back 3

the forefoot or any of it's compoent is palnatarflexed ont he rearfoot.

Front 4

What does posterior cavus eman?

Back 4

the reafoot is excessively dorseflexed on the forefoot.

Front 5

What are hte etiologies of pes cavus deformity?

Back 5

congential , acquired, or idiopathic

Front 6

When examing a patient wiht pes cavus deformity which part of the exam dewserves special attention? Why?

Back 6

The neurologic exam deerves pecial attentin because ther eis a high correlation between neuromuscualr disorder and pes cavus.

Front 7

What are some congenital eitologies of cavus deformity?

Back 7

myelodyplasia, melomengocel, spina bifida, charcot - marie tooth dieae freidreich' ataxia, Roussy-Levy syndrom, cerbral palsy , muscualr dystropy, clubfoot, syphilis, and hypertrophic interstial neuropathy (Dejerine-sottas syndrome)

Front 8

What are some acquired etiolgies of pes cavus?

Back 8

polimyelits, dystonia musculorum deformans, spinal cord tuors, taum, infeciton, lederhose diease, hysteri, and stroke

Front 9

What are some idiopathic etiologies of pes cavus?

Back 9

Those, which are intherint to th efoot, that crate the sagittal plane deformity of pes cavus.

Front 10

How does hte foot compensate for a cavus deformity?

Back 10

Retraction of the toes occurs whenther is overpowering or uopopsed pull by theextensor tendons. Tis occurs at rest nd is aggerated during swing phase leading to fixed defrmity. It amy als be the resutl of extensor substution. AS a reult of retrograde force from the digits, the metarsal heads becom more plantgrade. The extensor apparatus gains the mechanical advantage and the anterio cavus increases. Forefoot redution of hte flexble anterio cavus occcurs with ground reactive force. Thi si sabsorbed at he midtarsal level and if fully abasorbed hte foot wil appear normal during weigh bearing . If it cannot fully absorb the sagittal plane moitn necessary to reduce the foot (because the deformity is rigid) then the ankle will dorsiflex. This compensation for ht erigid anterio cavus leads to to a pseudo equinus as the taus becomes maximally dorsiflexed adn the clacaneal inclinatin angle increases. This high calcaneal inclination has traditionally been described as posterio cavus. This would raerly exist as the primary deforming force. The subtalar joint does not compensate for saggital plane anterio cavus deformity

Front 11

What is the relationship between forefoot varus and cavus foot?

Back 11

Forefoot varus can be thought of as lateral colun or hte 4th and 5th metarasal and cuboid being plantarflexed on hte rearfoot. This compensates with subtalar pronation and has the appearance of a high arched pronated foot.

Front 12

What is the relationship between forefoot valgus and cavus foot?

Back 12

Forefoot vlgus can be thought of as medial column ofr the 1, 2nd, 3rd metatarsals, the cuneiforms, and navicular being palntarflexed in respect to the rearfoot. This compensates iwth subtalr or midtarsal supination. in Subtalr supination the foot function as a high arched foot with no pronation and little shock absorbing capability. Lateral ankle instabilty may result due to the inveted psotion of calcaneus. With midtarsal supinatin the joint becomes unlocked, making the forefoot unstable, which cna lead to subtalar pronation.

Front 13

What is the relationship between first ray and cavus foot?

Back 13

Plantarflexed first ray can exist as
a) plantarflexed 1st metatarsal wiht metatrsal 1-5 invarus. n this casse metatrasls 2-5 must be more varus that of of 1-5. Compensatin for this foot ype will be similar ot that for forefoot varus exept there will bemore pressure on metatarsal heads 1 and 5 or 1 and 4 and 5. An anterior cavus in this type of plantarflexed 1st ray will be a high arch pronated foot with incrased pressur on the wigh bearing metarsal.
b) plantarflexed 1st metatarsal and varus attitude of metatrasa 2-5. Tis foot type may function relatively normally but with more pressure on metatarsals 1 and 5, or 1 and 4 and 5. Little pressure wil be borne on the 2nd and 3rd metarsal hads. An anterior cavus will increase the pressure on these metarsal
c) valgus position of metarsal 1-5. Compensation for this ty o fplantarlexed 1st ray will be simlar to that for forefoot valgus except there wil be incresed pressure on metarsal 1 and 5 or 1 and 4 and 5. An anterior cavus i this type ofplantarflexed 1st ra will cause additona pressure o nthe wiehg bearing mettarsal.

Front 14

What is hte relatinship between metarawsu adductus andcavus foot?

Back 14

metarsu adductus is a structual deformity in which th emetarsal areexcessively adducted in realtin to the lesser tarsu at lisfranc' joint. Tis deformity usually leads to an adducted gait with proantion being the compensation, thus unlockng the MTJ an dalowing abduction at Chopart's joint, which masks hte addction at Lisfaran' joint. A skew foor to z shaped foot results. Whe anteri cavus is superimposed o nthe metadductus foot, the ground reactive forces ar increased adding to the seveity of hte deformity

Front 15

What is pseudoequinus?

Back 15

pseudo equinus is not atrue limiation of ankle ldorsiflexion at the ankle joint but is rahter hte condition that exsists when available ankle dorsiflesion poetial is ued up in order ot compensate for an anterior equinus. Thus the ankle functions as if there is a limitation fo ankle dorsiflexion

Front 16

What is the relationship bewteen reafoot equinus and cavus foot.

Back 16

REafoot equinus ncludes those deformities, which restric ankle dorsiflexin . The include gasronemius, gastrosleus, osseous, and pseoduo equinujs. The sdeformities compensate by early heel-off or lack of heel contact. Compensatin may als lead to subtalr pronation with our without early heel-off , steppage gain, genu re

Front 17

What is the relation ship between reafoot varus and cavus foot?

Back 17

reafoot varus is adefomity n whch te psotero aspect of he alcaneu si invered realive ot the perpendicular when the subtal ajint is inthe neutral postion and thae paitent is in t he angle and bse of gaint. Compensation occurs by eversion to the perpendicular ot allwo the foot ot conatct the ground. Lateral ankle instabilty may result.

Front 18

what is the relationship beetween reafoot varus and cavus foot?

Back 18

reafoot varus is a deformity in whch th eposterio aspect of hte calcaneus is inverted realtive to the perpendicular when the subtalar joint is in the neutal psotion and th epaient is in the agnle and base of gaitn. Compensation occurs by everiosn to the perpendicular to allow the foot ot conatact the gorund. Lateral ankle instabilit mayu result when this condition cannot fully compensate

Front 19

What type of surgical procedures may be indicated for pes cavus in the faceof prgressive nuromucular diease

Back 19

joint stabilization or fusion procedures may be indicated when deformites are progresive. q

Front 20

When evaluating the weigh vearing reafoot posion in acavus foot, it is important o distinguish between an inverted calcaneus secondary to forefoot compensation and an uncompensate or partially compensated reaffoot varu. How is theis done?

Back 20

A valgus wedge is palced under the lateral forefoot. If he heel everts to perpendicular , then the inverted reafoot was secondary to forefoot compensaton. If the heel remains inverted with the forefoot wedge, then the inverted reafoot represens an uncompesnated or partially compensted reafoot varus.
This can also be accomplished by having he paient with the forefoot off the edge of as tep, thus eliminating hte forfoot infulence otn eh reafoot. if the heel evets to the perpendicular , then the inverted refoot was secondary to forefoot compensation. If he heel remains inverted, hten the inverted reafoot represens an uncompenated or partially compensated rearfoot varus

Front 21

What surgical procedure addresses the forntal palne comopnet of posteriro cavus or refoot varus?

Back 21

The tDwyer calcana l osteotomy, an extra- artiuclar procedure address this copent of cavus foot.

Front 22

Will the reduction of a fixed (rgid) anterior cavus deformity lead to signifant redution fo the calcaneal incination angle (posterior cavus)?

Back 22

yes it will

Front 23

Is a true ankle equinus (osseous , gaswtrocnemius, gastroslu) a common component of cavus foot?

Back 23

No! it is exeedingly rare. INappropriat gastrocnemius or stricps surgery may produce sever complications. especial talipes calcaneus typ of appropulsive gait.

Front 24

Do rigid hammertoes infuenc the evaluation of anterio cavus deformity?

Back 24

yes. The reverse buckling infuence of hte digits must be realsed in order ot evaluate the flexibilty of the anteir cavus

Front 25

Do radiographs help determine the rigdity or flexibilty of anterio cavus?

Back 25

Yes. Fi significant reduciotn th te cavus deformity is noted on coparison of the wight beraing and no-weigh bearing lateral radiogrpahs, some degree of felxibilty is assured.

Front 26

What is the role of plantar fasciotomies inc avus foot suergery?

Back 26

Fasciotomies are used to reduce the contracture of the palnar aponeurosis that is typical of a cavus foot. These realse are generally reserved for hte adolesdcent or pediatric patient when only forefoot deformities are present.

Front 27

What is the differnce between a subcuatnous palntar fasciotimy and Steindler Stripping?

Back 27

A subcutganeous faciotomy release only the plantar aponeruosis. The steindler striping relaease both the palantar aponeurosi and the plantar muclualture

Front 28

What are the effects of transferring the long extenso tendons to the metarsal heads or to the midtarsu

Back 28

It eliminateds defomring forces on the digits.
It helps compensate for mucle imalance responsible for creating flexible cavus.
It increases or maintains ankl edorsiflexor ower

Front 29

What is a JOnes suspension?

Back 29

An isolated transfer of hte extnesor hallucis longus to the neck of hte first metatrrawsal. Additonally, the hallux IPJ is fused. This procedure compensates for an overpoweing peoneus longus and flwxor hallucis longus

Front 30

What is a prereruisite for Jones suspension?

Back 30

an adequate dorsiflxory rang of mitn of hte fist ray.

Front 31

What are the ocnsequnces of over correction follwoing a Jones Suspension

Back 31

hallux limitus

Front 32

What is a Heyman procedure

Back 32

Transfer of all five long extensor tendons to their respeciv emetarasal heads. Tis procedure helps to reduce flexible anterior cavus. Tis procedure is raerly used todya. It is technically difficulat and has many complcations.

Front 33

What is the Hibbs prcedure

Back 33

TRansfer of hte extensor digitorum longus to the thrid cuniform to reduce a flexible aneriocavus. The orginal descripiton inculed a planar fascia and plantar muscle release

Front 34

What is a STATT procedure?

Back 34

The split tibalis anterior tendon transfer is anadunctivve procedure for treatment of flexible cavus foot. The latera one half of the anerio tibial tendion ia anstomosed ot he peroneus tertius tendon ner it insertion into the base of hte fifth metarsal. This us used whenthe EHL and EDLmuscles are weak bu the anteri tibial is a faull strenth.

Front 35

What is the purpose of the opeonus longus tendon tarnasfer to the lesser tarsu?

Back 35

This transfer is used ot help incrase ankle dorsiflexoin power and to reduce th edormp foot componet often seen with pes cavus. It also helps reduce palntarflexor forceo fht efirt ray

Front 36

How is the peroneus longus tendon tarnsfer done?

Back 36

The tendo is section e at he latera cuboid, routed through the interosseosus membranee, form lateral to anterio, and transfered downthe EDL tendon sheant and inserted into the lesser tarsu.

Front 37

What is the purpose of he tialis posterio tendion transfer

Back 37

Tis transfer is uded whn weak anterio group muscle causes a sropfoot. This transfer may requir reafoot stabilation (fusion) due to loss of the major supnat oof the foot.

Front 38

How is the tibialis posterio tednon transfer done?

Back 38

The tendon is secitoned at the navicular tuberosity, the tndon is roued thorhg the interosseous membrane, form posterior to anterior and ternasferred down the EDL tendonsheatn and inseted in to th lesser tarsu

Front 39

What is the prupose of hteperoneal nastomosis

Back 39

Tis prcedure decreses the palntarflexor forceo nt hfirt ray and increase the versio force of he foot. The porcedur is use as an adjuntive procedur only

Front 40

How is the peroneal anastomosi done?

Back 40

The peroneal longus is secured to th peroneus brevis at he level of the lateral ankle.

Front 41

What is a Cole procedure?

Back 41

A lesser tarsal ostoetomy designe to reuce a fixed anterio cavus . It preeserve subtalar and midtaral motion. It dos not correct varu so fhe calcaneu or comopensate for muscle imablance

Front 42

How is the Cole procedure done?

Back 42

This is a dorsal wedge osteotomy, apex plantarly, base dorsally, which extends from the cuboid laterally to opposit sieds of hte naviuclar - cuneiformjont medially. AFter the wedge is excised the forefoot is dorsflexed ot close the osteotomy and is faxted with pins or screws

Front 43

What are the diadvantages of the Cole procedur?

Back 43

Tis osteotomy results na shorter, thicker, wider foot because the deformity is correct by shortenign of the dorsa convex surface of he foot.

Front 44

What is a Japas Procdure?

Back 44

This is sa midtarsal "V" shaped osteotomy in which the apex is prxial usually wiht ne navicular and later limb of he V extends through the cuboid while the medial limb extends thrugh the first cineuiform. Themedial limb can extend throught hefirst metarsal base whena plantarflexed first metarsal is presnt. Not boen is excises. The proximal part of he dista bone segment is the shfted dorsally onthe proximal segment elevating hte forfoot andcrrecting the cavus. Pins are used ot fixate the osteotomy . A faciotomy is perfomed first.

Front 45

What are the disadvantage of teh COle and Japas procedures?

Back 45

Both procedures are difficult ot control accurately and both cause signifcant traum to the lesser tarsal - midtarsal area. Healing is slwo and hte amount of correction possible is less than with a terple arthrodesis. They genrally resutl in sles than a cosmetically pleaseing result.

Front 46

What is the truncated Trasometatrsal wedge arthdesei descrbed by Jahss.

Back 46

This is the escision of dorsal truncatd wdge of obne across the tarsometatrsal joints. The degre of anterio cavus determins the amount of obne resected at each joint. Sagittal and forntal plane corrections are possible. The plantar fascia, which is not released, helps hold hte foefoot in its corrcted posiotn. Internal fixation is sad to be unnecessasry. It is casted as usual

Front 47

What is thMcelvenny -caldwell procedure?

Back 47

This is afirst metatrsal cuneiform fusion for correctoin of aplatnarflexed first metarsal type onateriro cavus. It is uefou in neuromuscular diease to provide stabilzation.

Front 48

Can a fixed anero cavus be reduce by multiple dorsal wedge ostoetomis of two or more metarsals?

Back 48

yes

Front 49

What are the advantae of correcting fixe anterio cavus deformity at he metarsal level?

Back 49

This preves the funciotn of hte majo jonts of thelessertarsal and reafoot. Differnces n the leve of indvidual metarsal can be correcteed dt the time of srugrery. Disability is less than with mor proximal osteotomies. Thes procedurs can easly be done in conjunstio with muscl tendon balancing procedurs/

Front 50

What is Dwyer ostoetomy?

Back 50

This a lateral closing wedge ofseotom of hte calcaneus used to correct a rigid calcaneovarus deformityy The calcanus must be unalge to evert to the perpendicualr wehn weigh bearing with the forefoot infulence leminated.

Front 51

What are hte indications for hte Dwyer osteotomy?

Back 51

A rigid calcaneovarus deformity. The calcaneus must be unable to eert to the perpendicual rhwen weigh tberaring with forefoot infulence eliminated

Front 52

How is the Dwyer ostoetomy performed?

Back 52

A laterally basede wedge of bone is removed rom the clacneus just inferio and psoterior ot the peroneus longus tendon and parallel to it. The ostoetomy is clesd and fixated thus correcting the calcaneal vaurs. The complte correction fo the varus msut be obtaind.

Front 53

Describe the cresentic, biplante calcaneal ostoeotmy developed by smilson.

Back 53

This is a crsecentic osteotmoy at hte psoterio aspect of htecalcaneus in whch the pserio clacaneus isrotaed dorsally and any varu si derotated as well. THis allow reduction of the calcaneal inclination angle or sagittal palne deformity as well as any forntal plane varus.

Front 54

WWhat is the danger of dorsiflexor cacaneal osteotomy to correct psoteror cavus?

Back 54

AS a ruslot of rasing th eposteri calcaneus or reducitn the calcaneal inclinatio agnle, any rigd anerio cavus deformit present weill cause the talus to rock into furth dorsiflexion at he akle joint. This weill worsin pseduo equinus. This can avoid by correcting any fixed anterio cavus simlutaneously.

Front 55

What are the town manuevers whivch may be used durign tripole arthodesi to effect correction at th emidtars and subtala rjonts?

Back 55

Wedge resection
Displacing or slidng maneuvers

Front 56

What is the order ofjint resectin during a triple arthodesei?

Back 56

Midtarsal joint first then subtalar jont.

Front 57

What is the effecto f posterio dispalcement of hte clacanus durng triple arthdesis?

Back 57

This increase the power of he posterior muscle group by inceasing it sleve rarm at he ankle. The convers antrerio dispalcement o f calcaneus is useful in spastic conditon when the posteror muscle group tends to overpower the anterior group.