Chapter 115 - Tendon Disorders of the Foot and Ankle Flashcards
acute inflammatory arthritidies can lead to what?
enthesopathies - especially insertional achilles tendinitis
outcomes of perc achilles compared to open
- lower wound complications
- higher nerve injury
- equivalent:
return to activity
patient reported outcomes
rerupture rates
calf/ankle diameter
plantar flexion strength
outcomes of surgical vs non-surgical management of achilles tears
similar re-rupture rates
increased wound complications in surgical group
earlier strength recovery in surgical group - same strength at 1 year
chronic achilles rupture (<3mo)
primary repair
chronic achilles rupture (>3mo)
reconstruction with v-y turndown for gaps <4cm
augmentation or FHL transfer for gaps >5cm
three limbs of the posterior tibial tenon
anterior limb: inserts onto the navicular and the medial cuneiform
middle limb: inserts on the plantar surface of the middle and lateral cuneiform, cuboid, and 2-5 MTs
posterior limb: on the anterior sustentaculum tali
exam features in PTTI
- collapse of the medial arch
- hindfoot valgus
- forefoot abduction ad varus (too many toes)
- achilles/gastroc contracture
Stage I and II non op treatment of PTTI
UCBL with medial post
AFO
Stage III or Stage IV non op PTTI
fixed, no single heel rise
AFO or arizona brace (must cross ankle)
operative treatment of stage II PTTI
IIa = flexible deformity, noarthritis, difficult to do single heel raise, without forefoot abduction
- FDL transfer and medializing calcaneus osteotomy
IIb = same deformity PLUS forefoot abduction
- do the above surgery PLUS a lateral column lengthening
operative treatment of stage III
triple arthrodesis
if no CC arthritis can do limited subtalar +TN
Stage IV PTTI
pantalar arthritis = fusion
tibiotalar joint spared
- triple plus deltoid reconstruction
