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Flashcards in Pes planus Deck (20):
0

Name the causes of pes planus?

CONGENTIAL- vertical talus, tarsal coalition, flexible flatfoot, accessory navicula, calcaneovalgus foot

ACQUIRED- of which most common is
Posterior tibial tendon dysfunction
Then inflammatory Arthropathy
Sero negative spondylioarthropathy

1

Who most likely to get it?

Women, 60th decade

2

What is the aetiology ?

Multi factorial- 20% report acute injury
Tendon degeneration in watershed region- zone of hypo vascularity 2-6 cm from ptt attachment to navicular

3

What do pt complain of?

Medial ankle/ foot pain and weakness
Progressive loss medial arch
Lateral ankle pain- subfibular impingement- late

4

Clinical what do you see?

Pes planus
Hindfoot valgus- flexible 2, fixed 3-4
Forefoot abduction- too many toes
Rom- single heel raise- only in stage 1
FIXED VS FLEXIBLE- passively correctable on plantigrade foot

5

Where does tibialis post originate ?

Post tibia, fibula, intetosseus membrane

7

What is tibialis posterior innervation?

Post tibial n L4-5

8

What does tibialis posterior do after passing behind medial malleolus?

Splits into 3
Anterior- inserts navicular, medial cuneiform
Middle - inserts middle/ lat cuneiforms, cuboid mt2-5
Posterior - sustentaculum tail anteriorly

9

What is tibialis posterior blood supply?

Post tibial artery distally- watershed 2-6 cm between navicular and distal medial malleolus

10

What it is tibialis posterior function ?

Primary dynamic stabiliser of arch
Hindfoot inverter
Addicts and supinates forefoot during stance phase of gait
Secondary plantar flexor of ankle
Activation allows transverse tarsal joint to lock -> rigid lever arm for toe off phase of gait

11

Describe the classification of posterior tibial dysfunction and tx options ?

Stage I
Tenosynovitis I X-ray changes
Consx- wb cast 3-4 wks
Orthotics - medial heel lift, longitudinal arch support all custom
Surgery- SYNOVECTONY

11

How would you investigate pes planus?

Wb ap and lateral radiographs?

12

What angles would give you an idea?

Lateral talo first metatarsal angle- MEARY's greater than 4 degrees - pes planus
Calcaneal pitch - te angle formed between the flat of the ground and the inf edge of the ground- less than 11 degrees loss in arch height - normal 12-35 degrees

13

What is the diff with grade 2?

Broken down into 3 subgroups
2a
2b
2c

14

Describe the findings amd tx of grade 2a?

Pes planus
Flexible hindfoot- <40 degrees o uncovering of talus
No able to single heel raise
X-ray arch collapse
Consx- Physio & afo- good results
Surgery - fdl transfer to navicular + medial slide Calcaneal osteotomy

15

Describe the findings amd tx of grade 2b?

Flexible hindfoot and pes planus
FOREFOOT ABDUCTED- > 40 degrees uncovering - too many toes
No single heel raise
Arch collapse on X-ray
Tx- consx elderly orthotics as before
S= fdl transfer + lat column lengthening +/- medial Calcaneal osteotomy

16

Describe the findings amd tx of grade 2c?

Pp
Flexible hindfoot
Forefoot abducted
FIXED FOREFOOT SUPINATION
if stable medial column - navicular lines up with 1st mt= cotton osteotomy + fdl transfer, lat Column lengthenin ( dorsal open wedge cut to plantar flex 1st ray + medial side of calcaneous

17

Describe the findings amd tx of grade 3?

FIXED RIGID HINDFOOT
PP
FOREFOOT ABDUCTED
Pc - SEVERE SINUA TARSI PAIN
X-RAY- subtalar arthritis
Tx- TRIPLE ARTHRODESIS + TENDOACHILLES LENGTHENING

18

Describe the findings amd tx of grade 4?

Same as three but
DELTOID LIG COMPROMISE
Pc- ANKLE PAIN+ sinus TARSI pain
X-rays - TALAR TILT IN ANKLE MORTICE, subtalar oa
T - if ankle valgus flexible- triple ARTHRODESIS , TAL and deltoid reconstruction but
If ankle rigid and oa subtalar- TIBIOTALOCALANEAL ARTHRODESIS

19

What invokes A triple ARTHRODESIS ?

Fusion of
Subtalar
Calcaneocuboid
Talonavicular