Heel surgery

ajkim1's version from 2015-05-08 11:38


Question Answer
What kind of shoe can relieve plantar fasciitis?Higher heeled shoes
If conservative care worked, how long should it take for patient to have gotten better?6 wks
Phase I treatmentShoe gear, orthotics, stretching, icing, NSAIDs obesity counseling
Phase II treatmentInjection, night splint
Phase III treatmentSecond injection, imaging
Phase IV DDPlantar fasciitis, tarsal tunnel syndrome, other neurological entity
Phase IV plantar fasciitis treatmentESWT, surgery
Phase IV plantar fasciitis and tarsal tunnel syndrome treatmentSurgery
Phase IV plantar fasciitis and other neurologic entity treatmentESWT, surgery, treat the other entity
ESWTSound waves applied to tendon/ligament/fascia through coupling gel, super stimulating nerves, don't use local anesthesia
High energy ESWTOR procedure, MAC anesthesia, performed only once
Radial ESWTOffice procedure, no anesthesia, performed 3 times, 1 wk apart
ESWT post-opContinue phase I-III treatment, back to gym shoes and activities that same day
Radiofrequency coblationIonizes electrolytes in conductive medium, energized particles in plasma break molecular bonds, low temp preserves integrity of surround healthy tissue
Radiofrequency coblation MOAStimulation of angiogenesis and growth factors, increase in organized fibroblastic cells, interference with nociceptors
Radiofrequency coblation post-opBandage for 2 days, return to shoes and orthotics in 2 days, improvement within 1 week (can return to work then), 6-12 wks to show significant benefits
Endoscopic plantar fasciotomyIndicated for patients who have failed all other care
Endoscopic plantar fasciotomy post-opBandage and CAM walker 10-14 days, physical therapy, gym shoes with orthotics
Open fasciotomyMedial or plantar incision, identify and isolate plantar fascia, transect 33% of fascia
Resection of plantar fibromaIdentify the mass, incise over mass, resect mass, clean margins, close
What is no man's land in resection of plantar fibroma?Arch because it has a difficult time healing
Retrocalcaneal exostosis procedureIncise, resect exostosis, irrigate, and close
Haglund's deformity procedureBumpectomy and Keck and Kelly
Ideal radiographs for heelsFowler phillips, parallel pitch lines, total angle of Ruch
Fowler PhillipsIncreases with increasing posterior prominence
Fowler Phillips valueNormal <69
Parallel pitch linesPosterior enlargement
Total angle of RuchCalcaneal inclination + Fowler and Phillips
Total angle of Ruch value>75 is probably Haglund's deformity
Incision choicesLateral, medial, central (straight, curvilinear/lazy S
Lateral incisionLateral to the lateral aspect of the border of the Achilles
Medial incisionMedial to the medial aspect of the border of the Achilles
Central incisionOver central portion of Achilles
Worrisome about central incisionAngiosomes will dehisce and give people problems
Curvilinear incisionLazy S shape over central portion of Achilles
Procedural stepsIncise, indentify peritenon/tendon, incise and reflect Achilles, resect exostosis, anchor/reattach Achilles, repair peritenon, repair skin
3 anchoring techniquesSingle anchor, double anchor, speed bridge
Keck and Kelly indicationIncreased angle of calcaneal inclination with Haglund's deformity
Keck and Kelly procedureDorsally based closing wedge of calcaneus
Calcaneal osteotomies for AFFDKoutsougannis, Silver, MCDO, Calcaneal scarf, Z osteotomy
Calcaneal osteotomies for cavus footDwyer, Silver, LCDO, Calcaneal scarf

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