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TalipesEquinoVarus.pptx
- 1. Soft Tissue Procedures for Talipes Equinovarus Owen Morris
- 2. Talipes Equinovarus Most accepted theory Germ plasma defect-malposition of head and neck in talus 1/1000 live births M>F 2:1 50% B/l R>L 3 Components of Clubfoot (Triplanar deformity) Forefoot adductus, Rearfoot varus, Ankle equinus Simons rule of 15 Talo-Calcaneal angle is <15, talo-1st met angle is >15 Conservative Treatment (Ponsetti Method) Children <2 y/o Serial Casting Correct Adduction, then Varus, then Equinus
- 3. Initial visit CC: 5 year old male presents to clinic with right ankle joint pain HPI: Patients mother states her son has been wearing a right ankle brace since he was 2 years old. Patients mother admits that her son trips and falls a lot. Patients mother believes that her sons foot has gotten worse overtime.
- 4. Orthopedic Exam Right Left External Hip ROM 30 degrees 25 degrees Internal Hip ROM 45 degrees 45 degrees Malleolar torsion 12-13 degrees 10 degrees Blecks test 3rd interspace Medial 3rd toe Ankle DF -15 degrees KE, -10 degrees KF 10 degrees with KE, 15 degrees KF Patellar reflex 2/5 2/5 Achilles Tendon reflex 0/5 1/5 Additional: N/A Bulging talus prominent on lateral side
- 6. Walking
- 7. Surgical Plan Assessment: Severe Equinus of right foot secondary to Neonatal CVA, hemiplegia, Complete right toe walking Diagnosis: Right Spastic Equinus Deformity Operation: R Tendo Achilles Lengthening, Posterior Ankle Joint Capsular Release, Steindler Stripping, Posterior Tibialis Tendon Transfer, Flexor Hallucis Longus Tendon Deformity
- 8. Procedures 1. R TAL Z-plasty TAL was made with notable reduction of the equinus deformity Mild contracture was still noted Resection of the Plantaris Tendon and Posterior Ankle Capsule Release 2. Steindler Stripping Help reduce the cavovarus deformity of the foot Continued contracture to the hallux at the level of the interphalangeus was noted 3. FHL tendon lengthening Z-type lengthening procedure was made at the level of the flexor tendon 4. Posterior Tibialis Tendon Transfer
- 9. Post op- DP view Posterior splint, Webril, ACE bandage, and stockinette
- 10. 14 weeks post-op Ortho Exam Right Left Ankle DF 90 degrees 90 degrees 1st Ray ROM PF normal, limited DF WNL Hallux ROM WNL WNL Midtarsal ROM WNL WNL Subtalar ROM WNL WNL Structural Limb Length 53.25 cm 54 cm
- 11. 26 weeks post-op
- 12. 51 y/o Female with Neglected Clubfoot
- 14. Walking on her Talus
- 15. Surgical Plan Fix the Rigid Plantarflexed and Varus Hindfoot Soft Tissue Procedures First Achilles Tenotomy Posterior Tibial Tenotomy Posterior Ankle Capsulotomy Posterior Tibial Nerve Release
- 16. Surgical Plan Fix the Hindfoot Talectomy Fix the Forefoot Varus Midfoot Osteotomy Midterm Follow-Up of Talectomy for Severe Rigid Equinovarus Feet Evaluated the effectiveness of talectomy in the treatment of Dimeglio grade IV rigid equinovarus feet. Nineteen feet in 13 patients were treated by talectomy from September 2001 through January 2012 An anterolateral incision was made over the ankle and extended distally to the level of the navicular, and the head and neck of the talus were exposed starting from the anterior aspect of the ankle Complete removal of the talus was performed, and the foot was easily corrected to the neutral, plantigrade position. Posterior displacement of the foot was undertaken until the middle facet of the calcaneus was situated directly under the tibial plafond Postoperatively, all the feet improved to Dimeglio grade II and were painless
- 17. Dimeglio Classification System Four aspects of the deformity (the equinus, varus, rotation of the foot, and forefoot medial deviation) are scored on a scale of 1 (good) to 4 (bad) Four other categories (depth of posterior crease, medial crease, cavus, and muscle power) being assigned a present/absent score of 0 or 1 to give a total maximum score of 20
- 18. Surgical Plan Correct the Deformity Ilizarov or Hexapod frame Mechanical rigidity of the Ortho-SUV frame compared to the Ilizarov frame in the correction of femoral deformity Determined the rigidity of the OSF in its initial configuration and after dynamisation. The results were then compared with those obtained for the rigidity of fixation using the Ilizarov frame Results: The OSF, as tested in this study, is equal or better than the Ilizarov fixator in all zones in the femur and in all planes This is due to the fact that the four-threaded Ilizarov rods are located substantially in the sagittal plane. With the OSF, the struts lie in or near the frontal plane, which would explain the advantage of the OSF in frontal plane stiffness.
- 19. Surgical Plan Once deformity is corrected Tibiocalcaneal Fusion Associated Limb Length Discrepancy Biomechanical comparison of blade plate and intramedullary nail fixation for tibiocalcaneal arthrodesis Methods: Nine matched pairs of fresh frozen cadaveric legs underwent talectomy followed by fixation with a blade plate and 6.5-mm fully threaded cancellous screw or an ankle arthrodesis intramedullary nail Results: Intramedullary nail fixation demonstrated greater mean stiffness throughout the fatigue endurance testing, from cycles 10 through 250,000 (blade plate versus intramedullary nail Conclusion: Intramedullary nail fixation was biomechanically superior to blade plate and screw fixation in a tibiocalcaneal arthrodesis construct.
- 20. References El-Sherbini, Mostafa H., and Ahmed A. Omran. "Midterm Follow-Up of Talectomy for Severe Rigid Equinovarus Feet." The Journal of Foot and Ankle Surgery 54.6 (2015): 1093-098. Web. 20 Aug. 2016. Lee, Arthur T., Eric B. Sundberg, Derek P. Lindsey, Alex Hs Harris, and Loretta B. Chou. "Biomechanical Comparison of Blade Plate and Intramedullary Nail Fixation for Tibiocalcaneal Arthrodesis." Foot Ankle Int Foot & Ankle International 31.02 (2010): 164-71. Web. 20 Aug. 2016. Skomoroshko, Petr V., Victor A. Vilensky, Ahmed I. Hammouda, Matt D. A. Fletcher, and Leonid N. Solomin. "Mechanical Rigidity of the Ortho-SUV Frame Compared to the Ilizarov Frame in the Correction of Femoral Deformity." Strategies in Trauma and Limb Reconstruction Strat Traum Limb Recon 10.1 (2015): 5-11. Web. 20 Aug. 2016.