Cavus Foot

ajkim1's version from 2015-05-08 04:33


Question Answer
Cavus FootHigh arched foot, plantar flexed 1st ray, heel varus, can be flexible or rigid
Japas anterior cavusEquinus of the FF on the RF
Dysfunctional muscle groups of Japas anterior cavusAnterior and lateral muscle groups
Apex of Japas anterior cavus deformityMTJ, lesser tarsus, tarso-metatarsal
CORACenter of rotational angulation
Important of CORACore is the apex of the deformity, which is what we need to correct in surgery
Metatarsus cavus of Japas anterior cavusLis Franc's joint, prominence at MTJ
Lesser tarsus cavus of Japas anterior cavusEntire lesser tarsus, prominence at lesser tarsal area (entire midfoot)
FF cavus of Japas anterior cavusChopart's joint, lateral talar prominence
Lateral column of Japas anterior cavusMore flexible, compensates with STJ pronation, looks similar to FF varus
Medial column of Japas anterior cavusMay or may not be flexible, compensates with STJ supination, looks similar to FF valgus
Japas posterior cavusSTJ deformity with increased calcaneal inclination, decreased talar declination
Dysfunctional muscle groups of Japas posterior cavusPosterior muscle groups
Compensation of Japas posterior cavusSTJ pronation, forward shift of body balance
Ruch ClassificationFF deformity transitioning to RF cavus
Ruch stage IDeformity primarily restricted to MT, MTPJ, or digits
Surgical management of Ruch stage IDigital fusions, MTPJ release, extensor tenotomies, flexor transfers
Ruch stage IIRigid plantarflexed 1st ray and RF varus due to needing to supinate STJ to get lateral column down
Surgical management of Ruch stage IIDFWO, Dwyer, STATT, peroneal scarf, calcaneal scarf for varus
Ruch stage IIISevere global deformity and probable neuromuscular etiology
Surgical management of Ruch stage IIIMidtarsal osteotomies, triple arthodesis, tendon transfers
Etiology of Ruch stage IIINeuromuscular, congenital (hereditofamilial), traumatic, idiopathic
Etiology of flaccid staticPolio, trauma
Etiology of flaccid progressiveCMT, peripheral neuropathy (DM, alcohol), Friedreich's ataxia, muscular dystrophy
Etiology of spastic staticCerebral palsy, trauma, spina bifida, syringomyelia
Etiology of spastic progressiveSpinal cord tumors, brain tumors
MOA of flaccid staticRF plantarflexors are weak, FF plantarflexors are stronger (intrinsics), MTs are plantar flexed, calcaneal dorsiflexion
Order of muscle disintegration in flaccid progressiveIntrinsics, peroneals, TA, TP and gastrocnemius
Test for flaccid progressiveCheck tendons on dorsum of foot, check thinner muscles
Patient's history for cavus footFrequent falls and ankle sprains, shoes wear out easily (back and lateral)
PseudoequinusTalus is abutting tibia, talus is parallel to WB surface so it's can't dorsiflex adequately
Test to determine influence of 1st ray on RF varusColeman block test
Coleman block testGet 1st ray to floor to life off lateral column, RF comes to neutral or everted or stays in varus
Test to determine influence of FF on RFCarroll test
Carroll testFF dangles off block, RF goes to neutral or stays varus
Calcaneal inclination in flatfoot vs cavusDecreased, Increased
Talar declination in flatfoot vs cavus footIncreased, Decreased
Cyma line in flatfoot vs cavus footAnterior, Posterior
Fibular translation in flatfoot vs cavus footAnterior, Posterior
Sinus tarsi in flatfoot vs cavus footPartially obscured, Bullet hole
Calcaneal inclination angle valuesNormal 24.5, moderate cavus 25-40, severe cavus >40
Hibb's angleCalcaneal inclination, longitudinal bisection of the 1st MT
Hibb's angle values>160 pes planus, 130-160 normal, <130 pes cavus
Meary's angleLongitudinal axis of 1st MT and longitudinal axis of talus
Meary's angle values>4 convex upward (pes cavus), 0 normal, <4 convex downward (pes planus)
Best view for curvature of calcaneusAxial calcaneal view
Ankle viewsTalar tilt test, joint congruity, arthritis processes
Talar tilt or talocrural angleMortise view (line between 2 malleoli and line of dorsal aspect of talus)
Talar tilt or talocrural angle valuesNormal 79-87, Difference <3-5 degrees
Radiographic appearance of talar tiltShould be parallel to each other and floor
Labs for cavus footNCV/EMG, liver enzymes, lumbar puncture, myelogram, spine CT/MRI, genetic studies
Most plantar pressure cavus footLaterally
Most common cause of idiopathic pes cavusCongenital metatarsus adductus
Common associated conditions with cavus footLateral ankle instability, peroneal tendon pathology, repetitive tendon pathology, repetitive MT stress fractures, repetitive 5th MT fractures
Non-surgical management of cavus foot (broad)Orthotics, bracing, shoes, stretching
Goal of non-surgical managementPlantigrade foot that is amenable to ambulation
Orthotic treatmentFull length top cover, 1st ray cutout, arch fill, valgus post to lock MTJ and provide ankle stability
Bracing treatmentArizona brace, AFO
Shoe treatmentExtra depth shoes
When is it necessary to address the Achilles?If inadequate ROM
Sequence of cavus foot reconstructionSoft tissue release, RF fusion/osteotomy, MF fusion, MT/digital surgery, tendon transfers
Pathologic soft tissueSpring ligament, long plantar ligament, plantar fascia
FasciotomyRelieves plantar fascia, alleviates possibility of plantar fascia being a soft tissue deforming force
Steindler Stripping releases what structures?Plantar fascia, 1st layer of plantar muscles, long plantar ligament
Complications of Steindler StrippingCompromises NV structures, hammer toes
Dwyer osteotomy indicationCalcaneal varus
Dwyer procedureLaterally based closing wedge of calcaneus, (removing bone and moving posterior heel back on tibia), close and fixate with screw
Dwyer complicationsSural neuritis, malunion
Calcaneal scarf osteotomy indicationCavovarus deformity
Calcaneal scarf procedureLaterally based wedge taken from long arm of the osteotomy, triplanar correction, can angulate any direction (favorable to fix MT adductus)
Calcaneal scarf complicationSural neuritis
Triple arthrodesis foalsStable static re-alignment of foot, removal of deforming forces, arrest deformity progression, eliminate pain and decrease gait abnormalities
Triple arthrodesis indicationSignificant arthritis of handoff (STJ, TN, and CC joints)
Triple arthrodesis procedureMedial and lateral incisions, release any capsule or ligamentous tissue that is preventing reduction of deformity, cannulated short screws partially threaded at head
Triple arthrodesis resection orderTN, CC, STJ
Triple arthrodesis fixation orderSTJ, TN, CC
Triple arthrodesis complicationsDelayed or non-union, rural neuritis, stiffness, adjacent joint arthrosis
Cole osteotomy indicationRigid global anterior cavus
Cole procedureDorsally based wedge osteotomy of MF, spares TN and CC joints, plantar fascia release
Cole complicationsNon-union/malunion, shortening of foot, NV compromise
Japas osteotomy indicationRigid anterior global cavus
Japas procedureV osteotomy with apex in navicular, arms in medial cuneiform and cuboid joints, dorsiflex distal portion of foot
Japas complicationsNon-union/malunion, arthrosis, dorsal hump, NV compromise
Gianninni procedureClosing wedge of cuboid, navicular-cuneiform fusion, plantar fascia release
Principles of tendon transfers pre-opAdequate strength, ROM after transfer, in-phase vs out of phase
Principles of tendon transfers intra-opSmooth channel for excursion, maintain NV supply, straight line of contracture, reattach under sufficient tension
Principles of tendon transfers post-opNeed for post-op therapy
Jones indicationFlexible plantarflexed 1st ray
Jones procedureDetach EHL from mid shaft of proximal phalanx, reattach to 1st MT head
Jones complicationsLoss of EHL power, creation of new deformity
Procedure done after Jones to prevent hammertoeIPJ fusion
Hibbs tenosuspension indicationFlexible HDS
Hibbs tenosuspension procedureDetach EDL tendons 2-5, anchor tendons to 3rd cuneiform
Hibbs tenosuspension theoryDecreased dorsiflexion at MTPJs leads to decreased metatarsalgia
Hibbs tenosuspension complicationsInstability of MTPJs, NV compromise
Heyman indicationExtensor substitution hammer toes 1-5
Heyman procedureDetach EHL and EDL tendons, anchor to respective MT heads
Heyman theoryDecreased extensor substitution effect, dorsiflexes Mts so they're not so prominent plantarly
Heyman complicationInstability of lesser MTPJs
STATT indicationsSwing phase supinatus, TA is deformity force
STATT procedureTA split in half, medial 1/2 stays on cuneiform, lateral 1/2 attached to 3rd cuneiform
STATT complicationsLoss of function, overcorrection of RF deformity
TPTT indicationDrop foot, spastic equinus
TPTT procedureTP detached from insertion, transferred through interosseous membrane to dorsum of the foot
TPTT complicationsLoss of TP function, FF deformities
PL tendon transfer indicationDrop foot, rigid plantar flexed 1st ray in stance
PL tendon transfer procedure1/2 or all PL is transferred to 3rd cuneiform
PL tendon transfer complicationLoss of PL function
Peroneal stop indicationOveractive/spastic PL causing plantarflexion of 1st ray
Peroneal stop procedureTenotomize PL, suture PL to PB
Peroneal stop complicationsAlterations in peroneal function
External fixation indicationMore proximal problem