adult aquired flatfoot
DESCRIPTION
TRANSCRIPT
ADULT AQUIRED FLAT FOOT
DR. MANOJ R. KANDOI
M.S,FICS, DORTHO,DNB
• I AM THANKFUL TO MY TEACHER DR. SANZEORGAN,
UNIVARSITY OF WASHINGTON
AND ALSO TO DR. SIGWARD T. HANSEN ,FOOT CLINIC, HARBORVIEW MEDICAL CENRE SEATTLE
ADULT AQUIRED FLAT FOOT
• IT DEVELOPS ONCE SKELETAL MATURITY IS REACHED
• IS DIFFERENT FROM CONSTITUTIONAL WHICH IS PRESENT SINCE BIRTH
FLAT FOOT
LAT VIEW
CAUSES
• POSTERIOR TIBIAL TENDON DYSFUNCTION
• FRACTURE AND DISLOCATION
• TARSAL COALITION
• NEUROARTHROPATHY
• NEUROLOGICAL WEAKNESS
• IATROGENIC CAUSES
CAUSES OF TIB. POST DYSFUNCTION
• DEGANERATIVE
• INFLAMMATORY:R.A.,SERONEGATIVE SPONDYLOARTHROPATHY
• TRAUMATIC
PATHOPHYSIOLOGY
SUPPORT OF MEDIAL LONGITUDINAL ARCH:
1)STATIC (PLANTAR FASCIA,LONG AND SHORT PLANTAR LIGAMENT,SPRING LIGAMENT
2)DYNAMIC(TIBIALIS POST.WHICH CAUSES INVERSION OF MIDFOOT AND ELEVATION OF ARCH AND INDIRECTLYHINDFOOT INVERSION)
CLINICAL PRESENTATION
• PAIN AND SWELLING IN MEDIAL ANKLE AND MIDFOOT DURING WEIGHTBEARING
• LOSS OF ARCH• TENDENCY TO WALK ON INNERBORDER OF FOOT• LIMP• LOSS OF POSTURALSTRENGTH DURING GAIT• PAINFUL IMPINGEMENT BEETWEEN LATERAL
ANKLE AND FIBULA• ABNORMAL WEAR OF MEDIAL HEEL AND
INNERBORDER OF SHOE
SIGNS
• EXAMINATION IN STANDING POSITION WITH BOTH FOOT COMPARED
• EARLY STAGE, SWELLING ALONG POST. TIBIAL TENDON SEEN
• ARCH IS LOWERED
• FOREFOOT IS ABDUCTED
TOO MANY TOES SIGN
OTHER EXAMS
• TENDOACHILLES CONTRACTURE SHOULD BE LOOKED FOR IN KNEE FLEXION AND EXTENSION
• LOOK FOR TENDERNESS & IMPINGEMENT AT SINUS TARSI AND DISTAL FIBULAR AREA
LAB. INVESTIGATIONS
• CBC , ESR
• RA TEST
• HLAB27
• FBS TO R/O SENSORY NUROPATHY
STANDING LATERAL XRAYSOF PTT DYSFUNCTION
Stages of PTT dysfunction
STAGE1:
• PERITENDINITIS AND TENDON DEGENERATION
• TENDON LENGTH NORMAL
• PAIN & SWELLING ALONG TENDON SHEATH
STAGE 2
• LENGTHENING OF PTT
• CORRECTIBLE FLAT FOOT DEFORMITY
• DEFORMITY ON WEIGHTBEARING
• HINDFOOT AND MIDFOOT DEFORMITY CAN BE PASSIVELY CORRECTED TO NEUTRAL
STAGE 3
• FIXED HINDFOOT VALGUS
• RIGID FLATFOOT
STAGE 4
• DELTOID LIGAMENT ELONGATES
• VALGUS TILT OF TALUS IN ANKLE MORTISE
PA VIEW
DISTRACTION ARTHRODESISOF
CALCANEOCUBOID JOINT
THANK YOU