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70 Cards in this Set
- Front
- Back
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etiologies of pes cavus
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-congenital
-acquired -idiopathic |
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when examining a cavus pt, whatg is the most imp part of the exam
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-NM exam
-because there is a high correlation between NM disorders and cavus |
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cogenital causes of pes cavus
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-myelodysplasia
-myelomeningocele -spina bifida -CMT -freidrichs ataxia -roussy levy syndrome -CP -MD -clubfoot -syphillis -Dejerine Sottas syndrome |
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acquired etiologies of pes cavus
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-polio
-dystonia musculorum deformans -spinal cord tumors -trauma -infection -lederhose dz -hysteria -stroke |
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how does the foot compensate for cavus deformity
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-the midtarsal joint will absorb the sagittal plane motion during WB
-if the midtarsal cant, the ankle will absorb it by DF causing pseudoequinus -retraction of the toes occurs and extensors gain mech advantage |
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forefoot valgus and how does the foot compensate
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-PF of medial column or mets 1-3, navi and med cune
-foot compensates with midtarsal or STJ supination |
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what is pseudo equinus
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-not a true limitation of ankle DF
-but exists when available DF is used up to compensate for ankle equinus |
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surgical procedures for NM cavus
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joint stabilization or fusion procedures
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during coleman block test: the heel moves from inversion and everts to perpendicular: explain
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-the calc varus was secondary to FF compensation
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heel remains inverted upon coleman block test
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-the heel varus is uncompensated or due to a structural heel deformity
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surgical procedure that addresses the frontal plane of cavus foot
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-dwyer calc osteotomy
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is true ankle equinus a common component of cavus foot (osseous, gastroc,)
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no it is very rare
-so gastroc or achilles surgery may create complications or a apropulsive heel gait |
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when are plantar fasciotomies used in cavus foot
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-in kids when only forefoot deformities are present
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what is the diff b/w steindler stripping and plantar fasciotomy
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-steindler stripping releases the fascia and the plantar muscles
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jones suspension
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EHL to neck of first met
-common with IPJ fusion -compensates for an overpowering PL and FHL |
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Heyman Procedure
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transfer or 4 long extensor to their respective met heads
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Hibbs procedure
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EDL to third cuneiform
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STATT procedure
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-split tibialis anterior tendon transfer
-for flexible cavus foot -anastomize it to the PT tendon when EHL and EDL are weak |
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what is the purpose of the PL tendon transfer to the lesser tarsus for cavus
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-helps increase ankle DF power and reduce drop foot component of cavus
-also helps reduce PF force of 1st ray |
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if you perform a TP tendon transfer when weak anterior muscles cause dropfoot, what other procedure must be performed
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-rearfoot fusion bc you loose the strongest supinator
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Cole procedure
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-dorsal based wedge from TNJ to cuboid
-fasciotomy is performed to release a tight fascia |
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disadvantages of Cole procedure
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-shorter, thicker foot
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Japas
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-V cut through the navi and med cune to cuboid
-forefoot portion is shifted dorsally |
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McElvenny-Caldwell procedure
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-1st met cuneiform fusion for correction of PF first ray in cavus
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can a fixed anterior cavus be corrected by multiple dorsal wedge osteotomies of two or more metatarsals
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yes
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what is a dwyer and its indications
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-lateral based closing wedge of the calc; posterior and paralell to PL tendon
-used in rigid calc varus -the calc must be unable to evert to perpendicular when the FF influence is eliminated |
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Samilson: crescentic, biplane calc osteotomy
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-crescentic osteotomy at the posterior aspect of the calc
-allows for sagittal plane correction as well as varus correction |
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what is the danger of DFCO to correct posterior cavus
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-as a result of raising the posterior calcaneus or reducing the CI angle, any rigid anterior cavus deformity present will cause the talus to rock into furhtur DF of the ankle (this worsens pseudoequinus)
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order of joint resections during a triple
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-midtarsal first
-then subtalar |
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what is the effect of posterior displacement of the calc during triple arthrodesis
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-increases the power of the posterior muscle group by inc the leve arm
-conversely, anterior displacement of the calc is useful in spastic conditions when the posterior group tends to overpower the anterior group |
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Forresters Disease
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-diffuse idiopathic skeletal hyperostosis (DISH)
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3 mechanical foot types assoc with Haglunds
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-compensated RF varus
-compensated FF valgus -rigid PF 1st ray |
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Normal fowler and philip angle
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N = 44-69
> 75 = haglunds |
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angle of ruch
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-combined value of CI and fowler philip angle
- > 90 is pos for haglunds |
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borders of Kagers triangle
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-superior calc surface
-achilles -long flexor tendons |
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which nerve is often implicated as a cause of inferior calcaneal pain
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-nerve to abd digiti quinti
-aka Baxters nerve |
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primary structure that supplies venous drainage to the heel
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-small saphenous vein
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Duvries incisional approach for heel spur syndrome
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medial horizontal approach
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Miller and Vogel procedure
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-used for Haglunds
-combines the Keck and Kelly with resection of the posterior superior prominence and uses internal fixation -Keck and Kelly is only alone if high CI angle is present with no large prominence |
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what cystic lesion of the bone is seen in the calc
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-unicameral bone cyst
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which tarsal coalition has the highest prevalence
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-middle STJ
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best view for CN coaltion
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medial oblique
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how does a calc stress fracture appear on xray
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-vertical sclerotic band with in the normal trabecula pattern running perpendicular to the line of stress fx
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post op course for plantar fasciotomy with plantar incision
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-3 weeks NWB
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Kidner procedure
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-excision of accessory navi
-advancement of PT tendon |
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post op course for Kidner procedure
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-NWB cast in equinovarus for 4 weeks
-PWB for 4 weeks |
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what venous structures msut be encountered when performing soft tissue dissection along the navi tuber
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-medial marginal vein system (saphenous vein)
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xray view helpful for STJ coaltion
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harris beath
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os trigonum and associated structure
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FHL
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what ligament must be transected when performing a tarsal tunnel release
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-laciniate lig (flexor retinaculum)
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what is the last RF bone to appear after birth
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-navicular
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where does the medial aspect of heel get its blood
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-calc branches of PT and lateral plantar arteries
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MC complication after total plantar fasciotomy
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-lateral column pain (cuboid syndrome)
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at what age does the calc apophysitis close
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14-16
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calc fx appearance on Tech-99
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-inc uptake in all 3 phases
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saddle bone deformity
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-met cuneiform exostosis
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common neuritis with saddle bone deformity
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-deep peroneal nerve
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rupture of the achilles within the elderly population will most often occur at what location
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-insertion to the calc
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inferior heel spur would most likely be found in what muscle
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FDB
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describe the clinical presentation of retrocalc bursitis
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-pain on palpation of BOTH sides of achilles
-erythema and edema w/o pain on ankle ROM |
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entrapment of first branch of the lateral plantar nerve is an etiology of?
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heel spur syndrome (baxters)
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windlass mechanism was described by
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Hicks
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degenerative tears of the achilles are characterized by healing with what type of tissue
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adipose
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where does the lateral band of the plantar fascia insert
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styloid process of base of 5th met
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avg length of achilles in adult population
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15 cm
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intial tx of achilles tendonitis
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-ice
-heel lift -stretching -rest -NSAIDS |
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sensory innervation to medial and plantar heel pad
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medial calc (superficial branch of tibial)
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is the retrocalc bursa an adventitous bursa or anatomic bursa
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-anatomic; its presence is constant
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what forms the Fowler Philip angle
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-formed by the intersection of a line along the posterior calc and a line along the inferior calc
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how is achilles tendinosis defined radiographically
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-on lateral WB xray: greater then 9mm of thickening at a point 2 mm superior to bursal projection
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