Скачать или смотреть flexible flat foot (english version)

we will talk today about flexible flat foot.
Physiologic variant consisting of a decrease in the medial longitudinal arch and a valgus hindfoot and forefoot abduction with weightbearing.
100% of 2 y old child has flat foot which decrease to 4% at 10 y
Prognosis: most of the time resolves spontaneously.
generalized ligamentous laxity is common
25% are associated with gastrocnemius-soleus contracture
Classification:
Hypermobile flexible pes planovalgus (most common).
Flexible pes planovalgus with a tight heel cord.
Associated with an accessory navicular.
Rigid: tarsal coalition (least common) / TPPI in adult
pathoanatomy:
Valgus hind foot
Tight Achilles
Elevated first ray
Presentation:
usually asymptomatic in children
foot is only flat with standing and reconstitutes with toe walking, hallux dorsiflexion = (jack test).
hindfoot valgus corrects to a varus position with toe standing
evaluate for decreased dorsiflexion and tight heel cord (u have to supinate forefoot to lock Chopart joint)
Achilles contracture. The examiner holds the calcaneus in a neutral position and notes dorsiflexion of the ankle with the knee both flexed and extended (the Silfverskiold test). The result is measured in degrees of ankle dorsiflexion. A significant Achilles contracture limits the degree of correction possible with bracing and may require surgical correction.
Radiographs:
indications
painful flexible flatfoot: accessory navicular (focal pain at navicular)
rigid flatfoot: tarsal coalition (sinus tarsi pain) + congenital vertical talus (rocker bottom foot)
AP talocalcaneal angle = kite angle
Talonavicular angle
Meary’s angle is the angle measured on a lateral weight-bearing radiograph, between the long axes of the talus and first metatarsal, and is normally 0.
lateral talocalcaneal angle
the angle between the calcaneal inclination axis and the mid-talar axis
the angle between the lines bisecting the longitudinal axis of the two bones
25°: hindfoot varus - pes cavus
40°: hindfoot valgus - pes planus
Calcaneal pitch angle
Treatment
Nonoperative
Observation: asymptomatic patients, as it almost always resolves spontaneously
orthotics do not change natural history of disease
stretching for symptomatic patients with a tight heel cord
Operative to relieve pain if present???اوعى الشكل
Achilles tendon or gastrocnemius fascia lengthening flexible flatfoot with a tight heel cord with painful symptoms refractory to stretching
calcaneal lengthening osteotomy (Evans) (stretch the planter fascia)
medial sliding calcaneal osteotomy.
plantar base closing wedge osteotomy of the first cuneiform