Cavus Foot - PowerPoint PPT Presentation

1 / 30
About This Presentation
Title:

Cavus Foot

Description:

Cavus Foot N. Craig Stone M.D. F.R.C.S.(C) ... and any evidence of degenerative change Spinal Imaging as required Management Blah, Blah, Blah Orthotics For mild, ... – PowerPoint PPT presentation

Number of Views:140
Avg rating:3.0/5.0
Slides: 31
Provided by: CraigS152
Category:
Tags: cavus | foot | orthotics

less

Transcript and Presenter's Notes

Title: Cavus Foot


1
Cavus Foot
  • N. Craig Stone M.D. F.R.C.S.(C)
  • Discipline of Orthopedic Surgery
  • Sept 29, 2003

2
Cavus FootIntroduction
  • Definition
  • Anatomy and Pathomechanics
  • Etiology and differential diagnosis
  • Evaluation
  • Clinical and radiographic
  • Treatment

3
Cavus FootDefinition
  • Abnormal elevation of the medial arch in weight
    bearing
  • Fore foot equinus relative to hindfoot
  • ?whats normal/abnormal

4
Normal Anatomy and Biomechanics
  • Forefoot deformity and the windlass mechanism of
    the plantar fascia causative
  • Plantar fascia
  • Calcaneal tuberosity Transverse metatarsal lig
    slips to base of prox phalanx
  • Medial and central portions strongest
  • Stabilizes arch and inverts (with tib post) the
    hindfoot

5
Anatomy and Biomechanics
  • Choparts joint supple when hindfoot everted
  • Heel strike hindfoot inverted
  • Midstance hindfoot everted
  • Shock absorption now hindfoot supple
  • Toe off

6
Anatomy and Biomechanics
  • Toe off
  • Toes dorsiflex
  • Tib post fires
  • All to lock hindfoot
  • Gives a rigid, long lever for triceps surae

7
Pathomechanics
  • Foot musculature unbalanced
  • Usually intrinsic muscle weakness
  • Lumbrical weakness allows EDL to hyperextend the
    MCPs and FDL to flex the PIP and DIPs
  • Exaggeration of the windlass mechanism

8
Pathomechanics
9
Pathomechanics
  • Same applied to EHL and FHL
  • 1st ray more mobile makes it worse, forefoot
    supinates and may become fixed
  • Secondary hindfoot varus
  • Tripod effect

10
Pathomechanics
11
Pathomechanics
  • So why does it hurt?
  • Inverted hindfoot loses shock absorption ability
  • Recurrent ankle sprains
  • Tripod effects (less surface area)
  • Clawing of toes

12
Etiology
  • CNS
  • Spinal
  • Peripheral Nerves
  • Other
  • Idiopathic

13
Etiology - CNS
  • CP esp. hemiplegia
  • Spastic tib post
  • Friedreichs Ataxia (A. Recessive chrom 9)
  • Triad ataxia, downgoing Babinski, areflexia

14
Etiology - Spinal
  • Myelodysplasia
  • Syringomyelia
  • Polio
  • Spinal cord tumors
  • Tethered cord
  • Guillain-Barre syndrome

15
(No Transcript)
16
Etiology Peripheral Nerves
  • Hereditary Sensorimotor Neuropathy (HSMN)
  • Charcot Marie Tooth

17
Etiology - Other
  • Traumatic Isolated Tendon Injuries
  • Partial Sciatic Nerve injury
  • Volkmans Contracture

18
Etiology - Idiopathic
  • 20-50 of cases - mostly bilateral

19
Clinical Evaluation
  • History
  • Other neuro symptoms
  • Ulcers, numbness, bowel, bladder, Dev. Delay
  • Family History
  • Ankle Instability
  • Metatarsalgia

20
Clinical Evaluation
  • Physical
  • Dysraphism
  • Neuro exam
  • Coleman Block Test

21
Coleman Block Test
22
Radiographic Assessment
  • Standing AP and Lateral of Foot and Ankle
  • Assess angles (severity) and any evidence of
    degenerative change
  • Spinal Imaging as required

23
A Mearys Angle N 0 5 Degrees B
Calcaneal Pitch Angle N 30 degrees C Hibbs
Angle N lt45 degrees D Weight Bearing
Tibioplantar Angle N 90 degrees
24
Management
  • Blah, Blah, Blah
  • Orthotics
  • For mild, non progressive deformity
  • Lateral forefoot and hindfoot posting
  • Large toe box shoes

25
Management
  • Surgical
  • Treat underlying problem
  • Must decide if hindfoot is supple
  • Everyone gets a plantar fascial release
  • Fixed Supple is often subjective
  • Combination of procedures

26
Management
  • Hindfoot supple
  • Toe deformity correction
  • Girdlestone-Taylor
  • Forefoot correction
  • Metatarsal osteotomies
  • Midfoot osteotomy
  • Is there any role for a Jones procedure?

27
Management
  • Hindfoot supple
  • Tendon Transfers
  • If identifiable muscle imbalance
  • Split Tib post to peroneus brevis
  • Peroneus longus to brevis
  • Be careful in progressive disease

28
ManagementRigid Hindfoot
29
ManagementRigid Hindfoot
  • If deformity severe or Degenerative Changes exist
  • Triple Arthrodesis

30
Summary
  • Rare problem
  • Know causes and clinical assessment
  • Principles of treatment
Write a Comment
User Comments (0)
About PowerShow.com