Flat foot deformity

Question 1

Flat foot deformity- rational for surgical treatment

Answer 1

Pain, deformity with progression, instability, failure of conservative treatment

Question 3

rigid flat foot deformity classification

Answer 3

Tarsal coalition
Congenital vertical talus , neuromusclar Ffoot

Question 4

rigid pes plano valgus

Answer 4

Calcaneo navicular coalition
Talo calcaneal coaltion
Proneal spastic flat foot

Question 5

Acquired pes plano valgus

Answer 5

Tib post failure, spring ligament teaer, Sinus tarsitis, arthritis

Question 6

medial arch

Answer 6

Tib post is dynamic stabliliser of medial arch
Spring ligament is static stabliser of medial arch

Question 7

PTT is associated with

Answer 7

Spring ligament ( static stabiliser)
Sinus tarsi abnormality
Plantar fascia

Question 8

How to differentiate PTT and spring ligament insufficiency

Answer 8

Able to perfromed single leg raise with partial restoration of arch
Valgus hip and forefoot abduction indicate spring ligament insufficeny

Question 9

Calcaneonavicular coalition

Answer 9

None reducible to neutral position
Negative jack test
Comma sign in oblique plain x ray
Ap plain x ray-anteater sign

Question 10

What is Meary’s angle

Answer 10

-Long axis of talus should bisect navicular and first met
severe more than 30 degrees

Question 11

What is CYMA line from the X ray ?

Answer 11

Connceting TNj and CCJ- lazy S shape
Disruption of Cyma line indicates flat foot deformity

Question 12

What is AP Talocalcaneal angle?

Answer 12

-line bisecting the head and neck of the talus and a line running parallel with the lateral surface of the calcaneus. noromal value ranges from 15-30. A value of more than 30 indicates hindfoot valgus in pes planus
Primary plane of compensation is sagittal plane

Question 13

Surgical treatment of Tib post tendon dysfunction with flat foot

Answer 13

• Soft tissue procedure- subtalar arthroresis
  -Direct repair of torn ligament- Isolated spring ligament repair
• tendon transfer
  -Kinder procedure
  Osseus procedure:
  -Evans calcaneal osteotomy
  -Medial calc slide osteotomy
  -Triple arthro desis

Question 14

Medial displacement calcaneal osteotomy

Answer 14

FDL tendon sub
inficated for stage 2 tib post dysfunction

Question 15

Subtalar arthroresis

Answer 15

Sinus tarsi implant
Prevents external rotation of calc and encourage talus to internally rotate

Question 16

Kinder procedure

Answer 16

Excision of accessory navicular

Question 17

Evan’s calcaneal osteotomy

Answer 17

-increases length of lateral column
correction TP>FP>SP
Addresses too many toes

Question 18

What is the surgery option for stage 3 PTT dysfunction

Answer 18

Talonavicular joint arthrodesis

Question 19

Medial displacement calcaneal osteotomy?

Answer 19

increases calc pitch and medial arch height
Moves the gastroc complex medial to STJ axis

Question 20

Navicualr cuneiform arthrodesis

Answer 20

used in combination with gastroc lengthening

Question 21

Triple arthrodesis

Answer 21

correction in 3 planes- Severe arthritis
Combined with equines correction gastroc recession or achillies tendon lengthening
Flat foot is only suitable for surgery if asymptomatic