Flatfoot

Question 1

What compensation occurs with equinus in a pes valgus foot?

Answer 1

early heel off
STJ and MTJ pronation
medial column sag
TMTJ breech

Question 2

if a transverse plane deformity predominates, what kind of surgical correction would be indicated?

Answer 2

Evans osteotomy

Question 3

what radiographic findings would be indicative of a frontal plane dominant deformity?

Answer 3

• widening of the lesser tarsal area on DP view
• decrease of the 1st met declination angle
• decrease of height of sustentaculum tali
• increased superimposition of lesser tarsals on lateral view

Question 4

axis-altering arthroereisis (i.e. STA-peg) are used for flatfoot deformitiy exhibiting primarily what plane of deformity?

Answer 4

frontal plane

Question 5

what are some causes of rigid pronated feet?

Answer 5

vertical talus (congenital convex pes planovalgus)
tarsal coalition
peroneal spastic flatfoot
improperly corrected clubfoot

Question 6

Describe the axis of teh STJ.

Answer 6

42 deg from transverse

16 deg from sagittal

Question 7

what is the Hubscher maneuver?

Answer 7

in relaxed stance, the hallux is passively dorsiflexed to determine the flexibility of the arch. With passive dorsiflexion, the windlass effect is invoked, and this tightens the medial band of plantar fascia and FHL increasing the height of the arch

Question 8

what is the Kidner procedure?

Answer 8

resection of accessory navicular and transposition of the insertion of the tibialis posterior tendon to the underside of the navicular

Question 9

DEscribe the Young tenosuspension procedure.

Answer 9

rerouting the TA tendon thru a slot in the navicular w/o detaching the tendon from its insertion; tibialis posterior reattachment beneath the navicular and TAL if needed

Question 10

What does the Young’s tenosuspension serve to accomplish?

Answer 10

1. removes dorsiflexory force of TA on the 1st met and provides a mechanical advantage to plantarflexory force of PL to recreate medial column
2. distal portion of the tendon will become a strong ligament in the medial arch, running from the plantar
   aspect of the first metatarsal to the plantar aspect of
   the navicular
3. TA continues to function as primary dorsiflexor of the foot and ankle
4. TA continues to invert the foot along the MTJ

Question 11

Where is the osteotomy made for the evans procedure?

Answer 11

approx 1.5cm proximal to the CC joint

Question 12

how is the Evans osteotomy directed and why?

Answer 12

directed anteriorly to avoid the middle facet of the STJ

Question 13

Describe the Dwyer osteotomy

Answer 13

opening wedge with base laterally with bone graft (to correct cavus foot)
or reverse dwyer which is a medially-based closing wedge

Question 14

is the STJ axis fell parallel to the transverse plane, motion around the axis would primarily be in which plane?

Answer 14

frontal plane

Question 15

if the STJ axis is more vertical, what plane of motion will be dominant?

Answer 15

transverse plane

Question 16

imbalance or dysfunction of what muscle will quickly lead to a pes valgus deformity?

Answer 16

tibialis posterior

Question 17

what deformity is a contraindication for an Evans procedure? why?

Answer 17

met adductus; will cause exaggeration of the met adductus and in-toe gait

Question 18

what muscle will be encountered when performing the Evans procedure?

Answer 18

EDB muscle belly

Question 19

what muscles and tendons will be visible when dissecting for Young’s procedure?

Answer 19

TA tendon, TP tendon, ABH muscle

Question 20

what is the size of the bone graft used with the Evans procedure?

Answer 20

8-10mm (can’t do much larger because of increased CCJ pressure)

Question 21

ligamentous laxity can occur due to a defect in collagen synthesis. Name these disorders.

Answer 21

Ehlers-Danlos syndrome
Marfans syndrome
osteogenesis imperfecta

Question 22

instability of which column of the foot is more indicative of pathological flatfoot condition?

Answer 22

lateral column

Question 23

what are radiographic findings for a flatfoot with sagittal plane dominance?

Answer 23

increased talar declination angle
naviculocuneiform breech
increased talocalcaneal angle on lateral view
decreased calcaneoinclination angle

Question 24

posterior calcaneal osteotomies are most useful in the correction of flatfoot with what dominant plane of deformity?

Answer 24

frontal plane

Question 25

in what type of patient is usually arthroereisis performed?

Answer 25

adolescents (have not reached skeletal maturity)

Question 26

what are the primary and secondary goals for surgical correction of flatfoot deformity?

Answer 26

1) restoration of joint stability

2) restoration of height of teh arch

Question 27

describe the cyma line in a pronated foot.

Answer 27

anterior break in the cyma line

Question 28

what is Kite’s angle?

Answer 28

talocalcaneal angle

Question 29

what is an adjunctive procedure for a flatfoot correction?

Answer 29

TAL (for equinus)

Question 30

what is the most common cause of peroneal spastic flatfoot?

Answer 30

tarsal coalition

Question 31

for arthroeriesis to be effective, what must be reducible?

Answer 31

heel valgus as well as FF supinatus/varus

Question 32

which procedure elevates the posterior facet by insertion of a lateral bone graft beneath it?

Answer 32

Baker-Hill

Question 33

where is the osteotomy and bone grafting performed for a Selakovich procedure?

Answer 33

sustentaculum tali

Question 34

what special radiographic views would be helpful in evaluating a patient with flatfoot deformity?

Answer 34

1. charger view (stress DF) lateral view - assess for osseous equinus
2. Harris and BEath views- for tarsal coalition
3. neutral position WB DP and lateral views

Question 35

Which calcaneal osteotomy uses a bone graft under the sinus tarsi to block translocation of the talus under the calcaneus?

Answer 35

Chambers

Question 36

Describe the Koutsigiannis osteotomy.

Answer 36

medial displacement osteotomy of the calcaneus

Question 37

what radiographic findings are seen with a transverse plane dominant deformity?

Answer 37

1. increased talocalcaneal angle on DP
2. increased cuboid abduction angle
3. increased percetnage of TN uncovering
4. decreased forefoot adductus angle