Pes Cavus and Tendon Transfers

erimicrom's version from 2015-08-15 18:18

Pes Cavus

Question Answer
Definition of pes cavusequinus of the forefoot on the rearfoot
Two classification systems for pes cavusJapas and Ruch
3 Japas classifications of pes cavusanterior, posterior, combined
4 subtypes of anterior pes cavusmetatarsus cavus, lesser tarsus cavus, forefoot cavus, combined anterior cavus
Apex of metatarsus cavusLisfranc
Apex of lesser tarsus cavusentire lesser tarsal region
Apex of forefoot cavusChopart's
Apex of combined anterior cavusappears to be lesser tarsal region
Dorsal prominence at dorsolateral talar head noted inforefoot cavus
This classification system is the one that describes how to tx pes cavusRuch
Ruch stage 1Deformity of metatarsals and distal.
Ruch stage 1 sxDigital fusions, MPJ release, extensor tenotomies, flexor transfers
Ruch stage 2Rigid PFFR and RF varus
Ruch stage 2 sxDFWO, Dwyer, STATT, peroneal stop
Ruch stage 3severe global RF+FF deformity; likely NM etiology
Ruch stage 3 sxmidtarsal osteotomies, triple arthrodesis, tendon transfer
Most important angle in rigid pes cavus?calcaneal inclination angle
Normal calcaneal inclination angle24.5
Normal talar declination angle21
Moderate pes cavus calcaneal inclination angle30-40
Severe pes cavus calcaneal inclination angle40+
Hibb's angleintersection of the longitudinal axis of the calcaneus and the first MT
Normal Hibb's anglegreater than 150
Meary's angleintersection of the longitudinal axis of the talus and the first MT
Normal Meary's angle0
Hibb's is to ___, Meary's is to ___calcaneus, talus
5 step sequence of surgical cavus foot reductionsoft tissue release (plantar fasciotomy vs Steindler stripping), RF osteotomy / fusion, midfoot fusions, MT / digital surgery, tendon transfers
Coleman block teststick a block under the lateral forefoot to remove its influence on the RF. Tests RF flexibility
RF osteotomies / fusions for pes cavusDwyer calcaneal osteotomy, Hoke arthrodesis / "medial double" (STJ+TNJ), Dunn athrodesis (STJ, CCJ, Talocuneiform), triple arthrodesis
Who originally introduced the triple arthrodesis, and when?Ryerson, 1923
2 midfoot osteotomies for pes cavusCole wedge, Japas V
MT / digital surgeries for pes cavusMT DFWO (1st MT or multiple), digital arthrodeses
Name a zillion tendon transfer proceduresJones, Hibbs, Heyman, STATT, TPTT, PL transfer, peroneal stop
This condition is frequently sen with anterior cavuspseudoequinus
Pseudoequinusfunctional limitation of AJ DF caused by premature utilization of motion to compensate for rigid anterior cavus
Steindler strippingrelease of the plantar fascia and intrinsic musculature
Cavus causes ________ _________ of every joint from the MTPs to the AJreverse buckling

Tendon transfers

Question Answer
Jones tenosuspensionEHL sectioned and routed through / anchored to 1MTh
Jones tenosuspension requires this additional stephallux IPJ fusion
HibbsEDL tendons sectioned and secured to 3rd cuneiform. Digits are fused.
Heymanextensor tendons 1-5 sectioned and anchored to respective MT heads. Digits fused.
STATTTA split in half. Lateral transferred to PB (most commonly), tertius, cuboid or 3rd cuneiform depending on need.
Indication for STATTsupination deformity, exaggerated in swing phase
TPTTTP sectioned at navicular insertion, rerouted through interosseous membrne and secured to 3rd cuneiform
Whole PL transferinto 3rd cuneiform
Half PL transferinto PT and TA
Peroneal stopPL anastamosed with PB to reduce its effect on FR and increase foot eversion
Posterior tendon transferPL, TP or flexors anchored to calcaneus to assist weak Achilles
TAL and cavusdon't do it! Often worsens the deformity

Recent badges