What is flat foot Also known as Pes planus Medial border of the foot is abnormally in contact with the floor during weight bearing When associated with deformities of the hindmid and fore foot called ID: 1047943
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1. Arthroereisis in Flat foot
2. What is flat foot?Also known as Pes planus Medial border of the foot is abnormally in contact with the floor during weight bearing.When associated with deformities of the hind,mid and fore foot – called pes plano valgus
3. What is flat foot?Loss of normal medial longitudinal arch.NormalFlat foot
4. ARCHES OF THE FOOTMedial Longitudinal ArchLateral Longitudinal ArchTransverse Arch
5. Functions of the archesDistribution of the body weight on the bones of the foot.Giving the foot elasticity & resilience of movement during locomotion.Absorption of shocks when falling on the feet.Adaptation of the foot to irregular or sloping surfaces.Protection of the planter vessels & nerves.
6. Components of flat foot?Forefoot - abduction and pronation Talar head - displaced medially, anteriorly and downwardsCalcaneum everts, hindfoot is in valgusNavicular- subluxates dorso-laterally, uncovering the talar headThe medial column of the foot appears to be longer than the lateral column
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8. Too many toes sign
9. ClassificationHypermobile flexible pes planovalgus (most common)familialassociated with generalized ligamentous laxity and lower extremity rotational problemusually bilateralFlexible pes planovalgus with a tight heel cord Rigid flatfoot & tarsal coalition (least common) no correction of hindfoot valgus with toe standing due limited subtalar motion
10. Flexible flat footDecrease in the medial longitudinal arch and a valgus hindfoot and forefoot abduction with weight bearing.The foot can be put back into its “normal” position during non weight bearing.
11. Deformity correctable on tip toe standing
12. Jack’s testRestored medial arch by dorsiflexing big toe.
13. Prognosismost of the time resolves spontaneously.
14. Differential DiagnosisTarsal coalition : (Rigid flat foot)no correction of hindfoot valgus with toe standing due limited subtalar motionCongenital vertical talus (rocker bottom foot)Accessory navicular (focal pain at navicular)
15. Radiologicallyweightbearing AP foot: Evaluate for talar head coverage and talocalcaneal angleweightbearing lateral foot: Evaluate: Meary's angle Calcaneal pitchweightbearing oblique foot: rule out tarsal coalition
16. Meary's angle angle subtended from a line drawn through axis of the talus and axis of 1st raywill be apex plantar
17. 0 degrees >>>> Normal0 – 15 degrees >>>> Mild15 – 30 degrees >>>> Moderate> 30 degrees >>>> Severe
18. Calcaneal pitch Angle between the plantar surface of the calcaneum and horizontal on a lateral x-rayNormal 15 degrees , in flat foot is decreasedMay be 0 or negative in case of tightened TA
19. Prognosis & ComplicationsMany cases resolve spontanuosly. But>>>>>>>>>>>Excessive foot pronation (which usuallyoccurs with PP) may contribute to the development of foot pain and foot problems such as:Tibialis posterior dysfunction (because hyperpronation stretches this tendon).Hallux valgus (because more weight is borne by the medial metatarsals when the foot hyperpronates).Metatarsalgia (for the same reason).Plantar fasciitis.Knee pain
20. Aligned Feet = Aligned Body
21. Misaligned Feet = Misaligned Body!
22. No Symptoms Yet?Imagine your footacting as the tire onyour car.You can place the tire(or foot) on the groundwithout balancing it.• It functions great, forawhile. BUT…
23. Sooner or later it will wearout.Not only is the single tire(or foot) affected, but it can adversely affect the othertires – or the rest of our body.
24. TreatmentNonoperative Observation: always resolves spontaneously StretchingOrthotics UCBL Indications:asymptomatic patients, as it almost resolves spontaneously counsel parents that arch will redevelove with age.
25. UCBLUniversity of California Biomechanics Laboratory.Rigid plastic total contact DesignHind foot / mid foot correction.Heel cup extends proximally to inframalleolar area & distally to the metatarsal heads.
26. OperativeIndications for surgery are:Cerebral palsy with an equinovalgus foot, to prevent progression and breakdown of the midfoot.Painful PP.Tibialis posterior dysfunction, where non-surgical treatment is unsuccessful.
27. Achilles tendon or gastrocnemius fascia lengtheningindicationsflexible flatfoot with a tight heel cord with painful symptoms refractory to stretchingcalcaneal lengthening osteotomy (with or without cuneiform osteotomy) >> (Evans)
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29. Medial calcaneal sliding osteotomy
30. First of all it is pronounced r-throw-ear-e-sis“operative limiting of the motion in a joint that is abnormally mobile from paralysis” Dorland's Medical DictionaryArthroereisis
31. Derived from the fusion of the Greek roots arthro = (joint)Ereisis = (the action of sustaining, supporting, pushing against something)
32. Aims of ArthroereisisRestrict excessive range of motion at the subtalar joint without blocking it.Allow 3-5º of range of motionPreserve functionality of the subtalar joint
33. The goal is to stop the anterior progression of lateral process by some method within the outer half of the sinus tarsi.
34. The implant is inserted so that the tip touched the bisection of the talus.
35. AdvantagesMinimally invasive,effective low-risk procedure in the treatment of flatfoot
36. 2 Techniquesimpact-blocking devices:with the head place slightly more anterior so as to impinge with the talar lateral process limiting its anterior gliding and, consequently, its internal rotation
37. Male child , 6 years old, flexible flat foot
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39. After correction
40. self-locking implants, inserted in the sinus tarsi along its main axis, supporting the talar neck and avoiding contact between the talar lateral process and the sinus tarsi floor, thus limiting the talar adduction and plantarflexion.
41. Self lockingImpact blocking
42. TechniqueA lateral 1 cm to 4 cm incision just anterior and inferior to the tip of the malleolus, parallel to the skin tension lines. After debridement of the sinus tarsi, the hindfoot is manually supinated and a correct position of the foot is restored. K.wire insertion & a blunt probe is used to find the tunnel direction and progressive trial implants are used to choose the proper size under fluoroscopy; then the permanent device is implanted
43. 1st caseMale, 14 years old, flexible bilateral flat feet
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45. Beforeafter
46. 2nd CaseMale, 7 years old,, C.P Rt foot plano-valgus
47. Pre-operative
48. Heel valgus corrected by tip toe standing
49. After arthroereisis
50. After
51. BeforeAfter
52. 3rd Case12 years, Bil. flat feet
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54. After correction
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