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What is the postural definition of CONGENITAL clubfoot?
- FF adductus
- RF Varus
- Ankle Equinus
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Definition of TALIPES EQUINOVARUS clubfoot?
- FF adductus
- RF varus
- Ankle Equinus
- TN Subluxation
- Lateral rotation of the Talus in Ankle Mortise
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Of the congenital and Talipes which has a better prognosis and can be treated with conservative tx?
CONGENITAL
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Which is more ST?
Congenital
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What are Neuromuscular Disorderes that are acquired causing clubfoot?
- Polio
- Meningitis
- CP
- Spina Bifida
- Myelomeningocele
- Post-CVA
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What are some post trauma causes?
- Spinal cord trauma
- peripheral nerve trauma
- tendon laceration
- mal/nonionin
- volkman's contracutre
- burn contracture
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What is the talar neck declination angle in clubfoot?
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Where may the navicular go in a clubfoot?
- Plantar medial, may articulate with the MM
- Talus head is oriented plantar and medial also
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What is the orientation of the talus?
Lateral rotation with the head and neck medial plantar
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What is the general appearance of the LE on examination?
Foot is adducted, calf atrophy, smaller foot, wrinkles medial, prominent navicular, stretched skin lateral, fibula posterior
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What does Kite's angle do on TEV?
Decreases
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What does Lateral TC angle do?
Decreases
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When does the navicular ossify?
3 years old
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What angles do we look at to see if the navicular is subluxed?
- TC is <15
- Talo 1st met is >15
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When do you begin conservative treatment on clubfoot?
Immediantly
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You manipulate for 10-15 minutes and now what position or corrections are you going to apply in the casting?
- Abduct FF
- Evert Heel (Hatch says no)
- Distract Heel
- Above the knee cast for 1-2 weeks
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After casting for 1-2 months what other therpaies can be done?
- Night splints
- Prewalked shoes
- Orthotics
- Stretching
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What are some complications of serial casting?
- Rocker bottom foot
- Flat top talus
- Wedge shaped navicular
- Dorsal displacement of navicular
- AVN: Talus, navicular, distal tibia
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What age is ideal for sx?
3-12 months
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What is the squential release of clubfoot?
- Retract tarsal tunnel
- PT tendonw lengthening
- TN Joint Capsulotomy
- Sping ligament
- FDL tendon lengthening distal to knot of henry
- FHL lengthening
- Superfical deltoid ligament
- Interosseous ligament
- Calcaneofibular ligament
- Achilles tendon lengthening
- Posterio ankle joint capsulotomy
- Plantar fascia
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When would you do an osseous procedure?
- Recurrence
- Severe rigid deformity
- Performed only in the child and adult never in INFANTS
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What is the cincinnati incision?
- incision starts medially at the medial cuneiform bone, runs around the hindfoot at the same level, and ends at the cuboid bone laterally and a verticle incision to help link it.
- This is to release the peroneals and any tightness there that may be causing the calcaneus to internally or place fibula posteriorly. This is also to help reposition any osseous deformity noted.
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What osseous procedures?
- Medial column lengthening of the medial cuneiform opening wedge
- Lateral column shortening: Evans closing wedge, Lichtblau anterior calcaneal osteotomy, Ganley closing abductory cuboid osteotomy
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What other osteotomies?
- Cole: DF wedge
- Japas: V osteotomy
- DuVries: DF wedge at the MTJ
- Dwyer: Lateral closing wedge or opening medial wedge
- McElvenny-Caldwell procedure: DF Lapidus
- DFWO: of all mets
- Jahss: DF of all tarsometatarsals
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List all the ST procedures?
- Plantar fascial release
- Steindler Stripping
- Jones tenosuspension
- Heyman procedure
- Hibbs
- Split TA tendon transfer
- PL tendon transfer
- PT tendon transfer
- Peroneal Anastomosis
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How do you determine the apex of deformity?
Meary's Angle in cavus foot >5
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