Questions and Answers
What are some underlying orthopedic etiologies of flat foot? (Select all that apply)
Describe the planal dominance of the STJ.
42 degrees from Transverse, 16 degrees from Sagittal
Describe the planal dominance of the Oblique MTJ.
52 degrees from Transverse, 57 degrees from Sagittal
Describe the planal dominance of the Longitudinal MTJ.
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What are the clinical findings/tests of flatfoot? (Select all that apply)
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What are the lateral X-ray view findings of flatfoot? (Select all that apply)
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What are the AP X-ray view findings of flatfoot? (Select all that apply)
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What is the Harris Beath view good for evaluating?
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What is the long-leg calcaneal axial view good for evaluating?
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What are the classifications for flatfoot? (Select all that apply)
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What is the treatment for a Stage I Johnson and Strom?
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What is the treatment for a Stage II Johnson and Strom?
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What is the treatment for a Stage III Johnson and Strom?
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What is the treatment for a Stage IV Johnson and Strom?
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What soft tissue procedures can be done to treat flatfoot? (Select all that apply)
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What are the rear foot osseous procedures that can fix flatfoot? (Select all that apply)
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What are the midfoot/forefoot osseous procedures that can fix flatfoot? (Select all that apply)
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Study Notes
Orthopedic Etiologies of Flatfoot
- Compensated forefoot varus and rearfoot valgus contribute to flatfoot conditions.
- Deformities involving compensated and uncompensated adduction/abduction occur in flatfoot.
- Muscle imbalances, particularly Posterior Tibial Tendon Dysfunction (PTTD), play a significant role.
- Structural issues such as tarsal coalitions and forefoot valgus can lead to flatfoot.
- Equinus, or limited ankle dorsiflexion, often accompanies flatfoot.
- Ligamentous laxity is a common underlying factor in flatfoot formation.
Planal Dominance of Joint Angles
- Subtalar Joint (STJ) exhibits planal dominance with 42 degrees from the transverse plane and 16 degrees from the sagittal plane.
- Oblique Midtarsal Joint (MTJ) shows dominance at 52 degrees (transverse) and 57 degrees (sagittal).
- Longitudinal MTJ is characterized by 15 degrees from the transverse and 9 degrees from the sagittal plane.
Clinical Findings and Tests for Flatfoot
- "Too many toes" sign indicates forefoot abduction and is a key clinical marker.
- Differentiation between flexible and rigid deformity is necessary for diagnosis.
- Heel raise tests (single and double) help assess muscle function.
- Hubscher Maneuver and Rearfoot Control Stance Phase (RCSP) are critical examination techniques.
- Gait analysis provides insights into functional implications of flatfoot.
X-ray Findings of Flatfoot
- Lateral view reveals decreased Clinical Index of Arch (CIA) and increased Talometatarsal Declination Angle (TDA).
- Signs of midfoot incongruity are indicated by anterior break in the cyma line and Meary's angle.
- Anterior Calcaneal-Cuboid break may also be visible in lateral X-rays.
- Anteroposterior (AP) view highlights enlarged Talo-calcaneal angles and additional deformities like "skew" deformity.
Imaging Techniques for Evaluation
- Harris Beath view is useful for evaluating tarsal coalition.
- Long-leg calcaneal axial view focuses on identifying structural rearfoot deformities.
Classifications of Flatfoot
- Johnson and Strom classification assesses tendon involvement and degeneration stages.
- Funk classification differentiates based on intraoperative appearance of tendon injuries.
- Conti classification utilizes MRI to outline tendon pathologies.
- Jahss/Janis classification, also based on MRI findings, categorizes tendon conditions.
Stages of Johnson and Strom Classification
- Stage 1: Mild tendon degeneration and tenosynovitis, flexible rearfoot, negative "too many toes" sign.
- Stage 2: Advanced degeneration, flexible rearfoot, marked muscle weakness, positive "too many toes" sign.
- Stage 3: Rigid valgus rearfoot with ruptured tendon and marked widening on heel raise.
- Stage 4: Includes rigid ankle valgus alongside characteristics of Stage 3.
Treatment Options by Stage
- Stage 1: Conservative measures including tenosynovectomy and tendon debridement.
- Stage 2: Tendon transfers (FDL) and potential rearfoot arthrodesis.
- Stage 3: Isolated rearfoot arthrodesis or triple arthrodesis procedure.
- Stage 4: TTC and pantalar arthrodesis indicated for severe deformities.
Soft Tissue Procedures for Flatfoot
- FDL transfer involves sectioning the tendon and reattaching it to support the arch.
- Cobb procedure entails splitting and transferring the tibialis anterior tendon to help arch stability.
- Young's tenosuspension re-routes the tibialis anterior tendon through the navicular bone.
- Other methods include the anastomosis of peroneus brevis and longus to alleviate deformity.
Osseous Procedures for Flatfoot Correction
- Evans osteotomy: Opening wedge procedure to correct lateral column issues.
- Medial calcaneal slide and double calcaneal osteotomy enhance foot structure.
- Triple arthrodesis involves fusion of all three hindfoot joints; TTC and pantalar arthrodesis are for severe flatfoot.
- Procedures on the midfoot and forefoot include Cotton, Kidner, and various arthrodesis techniques.
Specific Surgical Procedures
- Evans osteotomy: Performed 1 cm proximal to calcaneal-cuboid joint.
- Koutsgiannis manipulation focuses on medial translation of the posterior calcaneus.
- Baker-Hill and Cotton procedures: involve opening wedge osteotomies with grafts for structural support.
- Miller and Lapidus procedures target first metatarsal and cuneiform joints for fusion.
- Hoke procedure fuses the navicular with cuneiforms to restore arch support.
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Description
Test your knowledge on the underlying orthopedic etiologies of flat foot and the planal dominance of the subtalar joint. This quiz covers key concepts essential for understanding flatfoot conditions, including various deformities and muscle imbalances. Ideal for students and practitioners in the field of orthopedics.
