Flatfoot (Surgery)

Question 1

When to consider surgical intervention?

1?

2?

3?

4?

5?

Answer 1

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

Question 2

How to approach surgery option for flatfoot?

1?

2?

3?

4?

5?

Answer 2

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

Question 3

What are the general procedures for flatfoot?

1?

2?

3?

4.?

5?

Answer 3

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)

Question 4

What is happening here?

Answer 4

Synovectomy of the PTT

Question 5

What’s Young’s tenosuspension?

1?

2?

Answer 5

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

Question 6

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

Answer 6

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

Question 7

What’s the function of Mitek anchor?

Answer 7

To anchor tendon to bone

Question 8

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.

Answer 8

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

Question 9

Some facts about arthroereisis:

Useful for 1?

2?

3?

Blocks 4?

Answer 9

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

Question 10

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

Answer 10

Hyprocure

Question 11

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

Answer 11

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

Question 12

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?

Answer 12

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.

Question 13

what are Contraindication To Evans?

Severe 1?

Severe 2?

Deformities that can not be corrected passively

Arthritis of the 3?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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?

Answer 15

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

Question 16

Some facts about Arthrodesis:

1? flat foot

Conditions such as 2?

3? flat foot

4? flat foot

5? fusion

6? coalition

Answer 16

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

Question 17

What is triple arthrodesis?

1? Joint

2? Joint

3? Joint

Answer 17

1. Subtalar joint
2. Talonavicular joint
3. Calcaneocuboid joint

Question 18

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

1?

2?

3?

Answer 18

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

Question 19

when is heel cord lengthening indicated 1?

When is it never indicated 2?

Answer 19

1. when the heel pitch is flat or even declined

see the picture

2. Heel Pitch Inclined Never Indicated

Question 20

1. What’s TAL?
2. What are indications for TAL?

Answer 20

1. TendoAchillesLengthening :)
2. GastroSoleal Equinus

Long-standing Deformity

Severe Contracture

Older Patients

Question 21

What are the indications for Gastrocnemius recession?

1?

2?

3?

4?

Answer 21

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

Question 22

What are the different approaches for TendoAchilles lengthening?

1?

2?

3?

Answer 22

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

Question 23

What do you do for Osseous Ankle Equinus?

Answer 23

Anterior talotibial exostosis (open or arthroscopic technique)

AND

Tibiofibular synostosis