79: Pes Cavus - Dayton Flashcards
static vs. progressive cavus foot etiology
- static = congenital deformity, post surg, post trauma
- progressive = neuromuscular dz, tendon rupture
- flaccid = charcot marie tooth, polio
- spastic = spina bifia, cerebral palsy, spinal injury
- *make your exam key in on neuromuscular tests and progression
deformity apex for the following …
metatarsus cavus
lesser tarsus cavus
forefoot cavus
- Metatarsus Cavus
- Lisfranc’s Joint
- Lesser Tarsus Cavus
- Cuneiforms
- Forefoot Cavus
- Midtarsal Joint
what tendons are at particular risk with cavus foot?
peroneal tendons (pronator - could be weak or damaged)
retrograde buckling
cavus deformity driven by the toe
fix the toes and fix the flexible cavus foot
coleman block test
- Lateral wedge under the 5th metatarsal head –>
- Forefoot dominant varus
- RCSP returns to vertical
- Hind foot dominant varus
- RCSP does not change
- Combined varus
- RCSP improves, but is not vertical
- Forefoot dominant varus
- Not a test for flexibility but flexibility is necessary for the heel to move after FF valgus is balanced
- Determines level of deformity
- Orthotic indication
what type of radiograph do you need?
has to be WB
especially want …
standing lateral, calcaneal axial, long leg axial, ankle views
pseudo equinus in cavus foot
- Calcaneal inclination is high and takes up the ankle ROM
- If you do a GS recession and an osteotomy to reduce the calcaneal inclination, you may create weakness and a “Calcaneous Deformity”
- Correcting the midfoot and forefoot deformities relieves teh psuedo-equinus
good indication for orthotics
flexible hindfoot with rigid FF valgus is a good indication for orthotics
best for spastic or flaccid paralysis
ex: cerebral palsy with spasticity
arthrodesis
principle tx options
static deformity
progressive deformity
significant weakness
- Static Deformity
- Osteotomy
- Tendon Transfers
- Progressive deformity
- Neuro-muscular dysfunction
- Fusions
- Significant weakness
- Tendon transfers result in one grade further weakness
- May want to consider fusion
soft tissue procedures
- for flexible deformity or adjuct to bone procedure
- Plantar fascia release
- Tendon transfers
- TATT or STATT
- Jones Suspension
- Relieves hallux buckling (hammertoe)
- Fusion of hallux IPJ with transfer of EHL to the neck of the first metatarsal
- Relieves the retrograde plantar buckling of the first metatarsal
- MUST be a flexible deformity
- Hibbs teno-suspension does the same thing for lesser digits
- Hibbs
- Relieves digit 2-5 buckling
- must be flexible at MTPJ
dwyer osteotomy
lateral closing wedge of calcaneus
- Reduce calcaneal varus
- Move posterior calcaneous lateral
- Improve standing position of the hind foot
- Reduce WB stress on the lateral column
- Due to the geometry, closing wedge osteotomy does not change calcaneal inclination
- Must do a slide or wedge with a slide to reduce inclination
- Must consider the contribution of the mid & forefoot
- If the apex is at the midfoot this needs to be addressed to drop the calcaneal inclination
- Technique
- Incision just behind and parallel to the peroneal tendons. Osteotomy 1 cm posterior to the subtalar joint and perpendicular to the axis of the calcaneus in the posterior body. Intact medial hinge. Dorsiflex foot to close while feathering medial cortex. Fixate with staple, screw or locking plate
identify
enlarged peroneal trochlea due to stress on peroneal tendons
indications subtalar arthrodesis
- Indications
- Severe instability
- Degenerative joint disease
- Deformity Correction
- Use rotation not wedging
triple arthrodesis
- Salvage for chronic pain with DJD
- ALWAYS correct the deformity
- Mobilize and prepare all three joints before fixation
- Congruous anatomic joint surfaces are preferable to planar or wedge fusion of surfaces
- Reduction Sequence
- Calcaneous – TN - CC
