Pes plenovalgus dr zahid h malik
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Pes plenovalgus dr zahid h malik
- 1. pes planus 10/1/2014 Zahid H Malik 1
- 2. Dr. Zahid H Malik PG Y-5 pes planus 10/1/2014 Zahid H Malik 2
- 3. WARNINGâŚ. THERE ARE QUESTIONS AT THE END OF THIS PRESENTATION
- 4. OBJECTIVES Anatomy Definition Imaging Types Presentation 10/1/2014 pes planus Zahid H Malik 4
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- 14. Tarsal Coalition & Peroneal Spastic Flatfoot 10/1/2014 pes planus Zahid H Malik 14
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- 18. Vid anat. 10/1/2014 pes planus Zahid H Malik 18
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- 20. Maintenance of the longitudinal arches The longitudinal arches are supported and stabilised by: The muscles whose tendons run into the apex of the arches and tend to increase their height (e.g. tibialis anterior) The muscles whose tendons run into the sole of the foot (e.g. peroneus longus tibialis post. and smallintrinsic muscles which also run longitudinally 10/1/2014 pes planus Zahid H Malik 20
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- 22. shape of the bones which allows them to interlock 10/1/2014 pes planus Zahid H Malik 22
- 23. A variety of longitudinally arranged ligaments which prevent the extremities separating, for example the long and short plantar ligaments and by the plantar calcaneonavicular ("spring") ligament. 10/1/2014 pes planus Zahid H Malik 23
- 24. The plantar aponeurosis links the extremities of the arches, and acts as the equivalent of a tie beam in an architectural arch. 10/1/2014 pes planus Zahid H Malik 24
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- 29. PES PLANUS AND PES VALGUS (âFLAT-FOOTâ) The term âflatfootâ applies when the apex of the arch has collapsed and the medial border of the foot is in contact (or nearly in contact) with the ground; the heel becomes valgus and the foot pronates at the subtalar-midtarsal complex. 10/1/2014 pes planus Zahid H Malik 29
- 30. 3 components that are involved in producing the alignment abnormalities of symptomatic adult flatfoot: collapse of the longitudinal arch hindfoot valgus forefoot abduction 10/1/2014 pes planus Zahid H Malik 30
- 31. Assesment of these components Each of these components can be assessed on either the lateral or AP view of the foot. 10/1/2014 pes planus Zahid H Malik 31
- 32. Assesment of these components COLLAPSE OF LONGITUDINAL ARCH Lateral: 1st metatarsal talar angle < 4 Lateral: Calcaneal pitch 18 to 20° FOREFOOT ABDUCTION AP: Talonavicular coverage angle AP: 1st metatarsal talar angle HINDFOOT VALGUS Lateral: Talo-calcaneal angle AP: Talo-calcaneal angle 10/1/2014 pes planus Zahid H Malik 32
- 33. OTHER SIGNS AP & Lateral: CYMA line 10/1/2014 pes planus Zahid H Malik 33
- 34. Calcaneal pitch 10/1/2014 pes planus Zahid H Malik 34
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- 37. Lateral talar - 1st metatarsal angle 10/1/2014 pes planus Zahid H Malik 37
- 38. MILD :greater than 4° convex downward is considered pes planus with an angle of 15° - 30° considered moderate , and greater than 30° severe 10/1/2014 pes planus Zahid H Malik 38
- 39. conve 10/1/2014 pes planus Zahid H Malik 39
- 40. Imaging 10/1/2014 pes planus Zahid H Malik 40
- 41. AP Talar - 1st metatarsal angle 10/1/2014 pes planus Zahid H Malik 41
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- 43. Lateral Talocalcaneal Angle 10/1/2014 pes planus Zahid H Malik 43
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- 45. AP Talocalcaneal angle (Kite's angle) 10/1/2014 pes planus Zahid H Malik 45
- 46. CYMA line A cyma line is an architectural term designating the union of two curve lines. A normal midtarsal joint should create a smooth cyma between the talonavicular joint and calcaneocuboid joint on both the AP and lateral views (Figures a). 10/1/2014 pes planus Zahid H Malik 46
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- 49. Flexible Pes Planovalgus (Flexible Flatfoot) Physiologic variant consisting of a decrease in the medial longitudinal arch and a valgus hindfoot and forefoot abduction with weightbearing Epidemiology incidence unknown in pediatric population 20% to 25% in adults Pathoanatomy generalized ligamentous laxity is common 25% are associated with gastrocnemius-soleus contracture 10/1/2014 pes planus Zahid H Malik 49
- 50. NATURAL HISTORY The arch is usually obscured in an infant's foot because of subcutaneous fat. Both footprint[26,39] and radiographic[42] studies of the child's foot demonstrate that the longitudinal arch develops during the first decade of life 10/1/2014 pes planus Zahid H Malik 50
- 51. This observation also leads to the overwhelming conclusion that prophylactic treatment of a typical flatfoot is unnecessary, with profound implications for the corrective shoe and insertâorthosis . Development of the arch is independent of the use of such external orthoses or the wearing of corrective shoes. 10/1/2014 pes planus Zahid H Malik 51
- 52. Presentation Symptoms usually asmptomatic in children may have arch pain or pretibial pain Physical exam inspection foot is only flat with standing and reconstitutes with toe walking, hallux dorsiflexion, or foot hanging valgus hindfoot deformity forefoot abduction 10/1/2014 pes planus Zahid H Malik 52
- 53. recommended viewsrequired weightbearing AP foot evaluate for talar head coverage and talocalcaneal angle weightbearing lateral foot evaluate Meary's angle weightbearing oblique foot rule out tarsal coalition 10/1/2014 pes planus Zahid H Malik 53
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- 55. 10/1/2014 The arch can often be restored by simply dorsiflexing the great toe (Jackâs test), and during this manoeuvre the tibia rotates externally (Rose et al., 1985). pes planus Zahid H Malik 55
- 56. pes planus 10/1/2014 Zahid H Malik 56
- 57. Differential Tarsal coalition Congenital vertical talus Accessory navicular 10/1/2014 pes planus Zahid H Malik 57
- 58. Treatment: Nonoperative observation, stretching, shoewear modification, orthotics indications asymptomatic patients, as it almost always resolves spontaneously counsel parents that arch will redevelop with age 10/1/2014 pes planus Zahid H Malik 58
- 59. Techniques athletic heels with soft arch support or stiff soles may be helpful for symptoms UCBL heel cups may be indicated for symptomatic relief of advanced cases rigid material can lead to poor tolerance stretching for symptomatic patients with a tight heel cord 10/1/2014 pes planus Zahid H Malik 59
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- 63. Operative continued refractory pain despite use of extensive conservative managemen. Achilles tendon or gastrocnemius fascia lengthening If flexible flatfoot with a tight heelcord with painful symptoms 10/1/2014 pes planus Zahid H Malik 63
- 64. calcaneal lengthening osteotomy calcaneal lengthening osteotomy (Evans) 10/1/2014 pes planus Zahid H Malik 64
- 65. sliding calcaneal osteotomy corrects the hindfoot valgus plantar base closing wedge osteotomy of the first cuneiform corrects the supination deformity 10/1/2014 pes planus Zahid H Malik 65
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- 67. Tarsal Coalition & Peroneal Spastic Flatfoot Congenital anomaly that leads to fusion of tarsal bonesand a rigid flatfoot results in syndrome peroneal spastic flatfoot most common coalitions are calcaneonavicular Slide 13 most common talocalcaneal talonavicular 10/1/2014 pes planus Zahid H Malik 67
- 68. Other forms calcaneocuboid, naviculocuboid, naviculocuneiform, 10/1/2014 pes planus Zahid H Malik 68
- 69. The true incidence of tarsal coalition is greater than the 1% usually quoted. Tarsal coalition appears to be inherited, probably as a unifactorial disorder of autosomal dominant . The specific type of coalition probably represents a genetic mutation that is responsible for failure of the primitive mesenchyme to segment 10/1/2014 pes planus Zahid H Malik 69
- 70. age of onset calcaneonavicular 8-12 years old talocalcaneal 12-15 years old Pathophysiology mesenchymal segmentation leading to coalition of tarsal bones coalition may be fibrous cartilagenous osseous 10/1/2014 pes planus Zahid H Malik 70
- 71. Associated conditions multiple coalitions are associated with fibular deficiency Apert syndrome 10/1/2014 pes planus Zahid H Malik 71
- 72. Presentation Symptoms pain worsened by activity onset of symptoms correlates with age of ossification of coalition calf pain secondary to peroneal spasticity recurrent ankle sprains 10/1/2014 pes planus Zahid H Malik 72
- 73. Physical exam inspection & palpationpes planus collapse of the medial longitudinal arch 10/1/2014 pes planus Zahid H Malik 73
- 74. The medial border of the foot from just behind the first metatarsal head to a point about 2 cm distal to the calcaneal tuberosity should be elevated from the floor when the subject is standing. The apex of this arch is usually about 1 cm. 10/1/2014 pes planus Zahid H Malik 74
- 75. system for grading Jack described a general system for grading the morphology of the medial longitudinal arch. grade I arch is subjectively slightly depressed on weightbearing. grade II arch, the entire medial border of the foot touches the floor but its edge is straight. grade III arch, the entire medial border of the foot not only touches the floor but also bulges toward the examiner in a convex manner 10/1/2014 pes planus Zahid H Malik 75
- 76. Physical exam inspection hindfoot valgus forefoot abduction range of motion limited subtalar motion heel cord contractures arch of foot does not reconstitute upon toe-standing 10/1/2014 pes planus Zahid H Malik 76
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- 79. Peroneal spastic pes planus. Tarsal coalition, rigid pes planus, and peroneal muscle spasm together as essential components of Peroneal spasm actually is an acquired or adaptive shortening of the muscle-tendon units 10/1/2014 pes planus Zahid H Malik 79
- 80. Stretch reflex of a shortened muscle-tendon unit Inversion stress by the examiner, producing an unsustained three-four-beat clonus of the peroneal muscles,. That peroneal muscle tight-ness is the frequent resultof tarsal coalition and not the cause must be emphasized 10/1/2014 pes planus Zahid H Malik 80
- 81. Peroneal muscle tightness is seen in rheumatoid arthritis, osteochondral fracture, and infection in the subtalar joint (tuberculous, mycotic, or pyogenic), or neo-plasm (osteoid osteoma, osteochondroma, fibrosarcoma) adjacent to the subtalar joint in the talus or calcaneus. The relaxed position of the subtalar joint is valgus, which places the least strain on the talocalcaneal interosseous ligament according to Lapidus. 10/1/2014 pes planus Zahid H Malik 81
- 82. Imaging Radiographs recommended views Required anteroposterior view standing lateral foot view 45-degree oblique view most useful for calcaneonavicular coalition Slide 30 10/1/2014 pes planus Zahid H Malik 82
- 83. calcaneonavicular coalition "anteater" sign elongated anterior process of calcaneus talocalcaneal coalition talar beaking on lateral radiograph occurs as a result of limited motion of the subtalar joint 10/1/2014 pes planus Zahid H Malik 83
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- 85. Congenital talonavicular tarsal coalition (anteroposterior, lateral, and oblique views). 10/1/2014 pes planus Zahid H Malik 85
- 86. Calcaneonavicular incomplete tarsal coalition. 10/1/2014 pes planus Zahid H Malik 86
- 87. CT scan necessary to rule-out additional coalitions determine size and extent of coalition MRI may be helpful to visualize a fibrous or cartilagenous coalition 10/1/2014 pes planus Zahid H Malik 87
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- 89. Treatment Nonoperative observation asymptomatic cases immobilization with casting or orthotics initial treatment for symptomatic cases 10/1/2014 pes planus Zahid H Malik 89
- 90. Operative surgical resection of coalition with interposition of fat graft or extensor digitorum brevis resistant cases when nonoperative management fails to relieve symptoms subtalar arthrodesis triple arthrodesis (subtalar, calcaneocuboid, and talonavicular) advanced coalitions that fail resection 10/1/2014 pes planus Zahid H Malik 90
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- 92. Resection of calcaneonavicular tarsal coalition. 10/1/2014 pes planus Zahid H Malik 92
- 93. Resection of middle facet tarsal coalition 10/1/2014 pes planus Zahid H Malik 93
- 94. Self-locking wedge. B,Axis-altering device. C,Impact-blocking device. 10/1/2014 pes planus Zahid H Malik 94
- 95. Questions
- 96. ? 10/1/2014 pes planus Zahid H Malik 96
- 97. 10/1/2014 pes planus Zahid H Malik 97
- 98. What s this shows?? 10/1/2014 pes planus Zahid H Malik 98
- 99. pes planus Zahid H Malik ve a nice day Thanks for your participation 10/1/2014 99
Hinweis der Redaktion
- From architecheral point of view ⌠these thing need for a high arch bridge .. Nature as used all these principles.
- 18 to 20°
- CRANIOFACIAL DYSPLASIA The best-known of these conditions is Apertâs syndrome (acrocephalosyndactyly). The head is somewhat egg-shaped: flat at the back, narrow anteroposteriorly, with a broad, towering forehead, depressed face, bulging eyes and prominent jaw