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PodMed > Flatfoot (Surgery) > Flashcards

Flatfoot (Surgery) Flashcards

1
Q

When to consider surgical intervention?

1?

2?

3?

4?

5?

A
  1. Painful flat foot not responsive to conservative care
  2. Orthotics
  3. AFO
  4. Bracing
  5. NSAIDS
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2
Q

How to approach surgery option for flatfoot?

1?

2?

3?

4?

5?

A
  1. Age of the patient
  2. Flexible Vs Rigid
  3. Planal dominance
  4. Radiographic measurements
  5. Is Equinus present
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3
Q

What are the general procedures for flatfoot?

1?

2?

3?

4.?

5?

A
  1. Soft tissue procedures
  2. Arthroeresis
  3. Osteotomies (Depending on the planal dominance)
  4. Soft tissue/tendo transfers and osteotomies
  5. Fusion/arthrodesis STJ/ medial column (stage 4, when doesn’t reposnd to anything else)
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4
Q

What is happening here?

A

Synovectomy of the PTT

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5
Q

What’s Young’s tenosuspension?

1?

2?

A

  1. another soft-tissue procedure rerouting of tibialis anterior tendon to bring it more plantarly so that stabalise the medial longitudinal arch distally
  2. doing this will not change the rearfoot positionit will increase the forefoot abduction
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6
Q

Kinder procedure (based on lecture notes)

1? is identified within the substance of the tendon and is 2?

 If the 3? is to be rerouted through the navicular, it is detached as 4? as possible

 If there is a significant prominence to the 5?

Rerouting PTT by drilling a hole plantarly to dorsally, passing the tendon through the whole and suturing it to it self

OR Mitek anchor

A
  1. The accessory navicular or os tibiale externum
  2. excised with sharp dissection
  3. tibialis posterior tendon (PTT)
  4. distally
  5. medial tuberosity of the navicular, it is osteotomized and resected
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7
Q

What’s the function of Mitek anchor?

A

To anchor tendon to bone

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8
Q

The concept of arthroereisis:

The concept of arthroereisis is the insertion of a device in the 1? to block 2? against the 3? during 4? which is prolonged in the flexible flatfoot.

A
  1. Sinus tarsi 2. the contact of the lateral process 3. calcaneal sinur floor 4. maximum end-range pronation
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9
Q

Some facts about arthroereisis:

Useful for 1?

2?

3?

Blocks 4?

A
  1. flexible flat foot
  2. Paediatrics
  3. Posterior tibialis function
  4. STJ pronation
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10
Q

What’s the name of the implant used in arthroereisis?

A

Hyprocure

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11
Q

Lateral column lengthening /Evans

Painful 1?

2? adult acquired flat foot

Significant 3?

It has allowed patients with more severe deformity to gain adequate correction of the triple joint complex

A
  1. pes plano valgus
  2. Stage 2 (The books says stage3)
  3. transverse deformity (the forefoot is ABducted)
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12
Q

Evan’s as illustrated by Coughlin and Mann

An incision is made 1?

Once on the floor of the sinus tarsi, dissection is made 2?

3? is placed as a guide for the osteotomy cut

To avoid too small a distal fragment 4?

Make the cut, taking care not to plunge through the medial cortex

Open the osteotomy site laterally insert 5?

Fixation with 6?

A
  1. longitudinally along the sinus tarsi just above its floor, ending at the calcaneocuboid joint
  2. subperiosteally over the anterolateral calcaneus, mobilizing and retracting the peroneal tendons away from the lateral calcaneus.
  3. A K-wire
  4. place the pin 1.5 cm proximal to the calcaneocuboid joint, aiming 10 to 15 degrees posteriorly from a direct perpendicular to the lateral calcaneus.
  5. the graft (iliac crest or allograft)
  6. 3.5mm lag screw and or staples and etc.
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13
Q

what are Contraindication To Evans?

Severe 1?

Severe 2?

Deformities that can not be corrected passively

Arthritis of the 3?

A
  1. Bone metabolism disorder, poor diabetes with neuropathy
  2. Osteoporosis
  3. STJ or Chopart joint, stages 3,4 Johnson and Strom
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14
Q

What are some of the Post-op Complications of Evans?

Wound 1?

Delayed 2?

Collapse 3?

4? of bone wedge

Neuritis of the 5? nerve

Stress fracture of the 6?

7? arthritis as a result of impaction

A
  1. infections and dehiscence
  2. bone healing and non union
  3. of the osteotomy surfaces
  4. Dislocation
  5. lateral dorsal cutaneous
  6. 5th metatarsal
  7. Calcaneocuboid
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15
Q

What is the Koutsougianis procedure?

based on the book:

By means of an 1? osteotomy through the 2?, Koutsougianis described displacement of 3? fragment medially to lie beneath the 4?

A
  1. Oblique 2. body of calcaneus
  2. posterior (top) fragment
  3. sustentaculim tali
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16
Q

Some facts about Arthrodesis:

1? flat foot

Conditions such as 2?

3? flat foot

4? flat foot

5? fusion

6? coalition

A
  1. Rigid
  2. Arthralgia/OA/RA
  3. Neuromuscular/spastic
  4. Stage 3 and 4 Adult aquired
  5. Isolated
  6. Tarsal
17
Q

What is triple arthrodesis?

1? Joint

2? Joint

3? Joint

A
  1. Subtalar joint
  2. Talonavicular joint
  3. Calcaneocuboid joint
18
Q

What are the contraindications for triple arthrodesis (basically joint fusion)?

1?

2?

3?

A
  1. Young children less than 12 yrs old
  2. Relative CI conditions
  3. Chronic smoking
19
Q

when is heel cord lengthening indicated 1?

When is it never indicated 2?

A
  1. when the heel pitch is flat or even declined

see the picture

  1. Heel Pitch Inclined Never Indicated
20
Q
  1. What’s TAL?
  2. What are indications for TAL?
A
  1. TendoAchillesLengthening :)
  2. GastroSoleal Equinus

Long-standing Deformity

Severe Contracture

Older Patients

21
Q

What are the indications for Gastrocnemius recession?

1?

2?

3?

4?

A
  1. Gastrocnemius Equinus
  2. Lesser Degree of Equinus
  3. Young Patients
  4. Easier Recovery
22
Q

What are the different approaches for TendoAchilles lengthening?

1?

2?

3?

A
  1. Tenotomy –Open or Percutaneous
  2. Percutaneous –Series of Stabs, 18 Ga. Needle
  3. Open Frontal “Z” –Controled Length
23
Q

What do you do for Osseous Ankle Equinus?

A

Anterior talotibial exostosis (open or arthroscopic technique)

AND

Tibiofibular synostosis

24
Q
A

PodMed (29 decks)

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