Pediatric Pes Planovalgus Deformity (Biomechanics II)

Characteristic Findings of Pes Planovalgus Deformity ? a. _________ Calcaneus? b. Talar head ? c. __________ plane abd/add -uction of the midfoot - Collapse of the ______ _________ arch - Hyper or Hypo mobility? - ________ gait/equinus - Too many ______ sign

- Everted Calcaneus - Medial talar head prominence - Transverse plane abduction of the midfoot - Collapse of the medial longitudinal arch - Hypermobility - Pronated gait/equinus - Too many toes sign

Limb length discrepancy

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Diagnosis and Categorization of Flatfoot Congenital... what are the common dx?

1. Calcaneovalgus (CCV) - More common in females - Must rule-out Vertical Talus - May require casting 2. Convex pes planus - Vertical Talus - Half cases with NM disorders 3. Tarsal coalitions - CN and TC account for 90% 4. Super structural Etiologies - Hip, Knee, Tibia, Ankle, Foot 5. Rigid Acquired - Peroneal spastic flatfoot Iatrogenic rigid Flatfoot (TEV, CCVT, Failed FF Surgery)

A Comprehensive Biomechanical Exam should include what tests?

1. Hip (rotation with extension and flexion) 2. Femoral Torsion (Ryder's Test) 3. Knee motion (10-15 degrees for newborn to 0 at 1) 4. Tibial Torsion 5. Equinus 6. RCSP 7. Forefoot to Rearfoot position

Pes Planovalgus Deformity Acquired: ? Congenital: ?

Acquired: Calcaneal Valgus Congenital: Congenital Vertical Talus

Angles: TC CIA TDA T-1st Met

All abnormal pathology of flat feet will increase angles, except CIA, which decreases.

deforming forces associated with acquired pes planovalgus in Sagittal Plane?

Equinus Gastrosoleus Hamstring Iliopsoas

Ryder's Test

Femoral Torsion Internal femoral torsion reduces from 30 degrees newborn to 10 degrees at maturity

deforming forces associated with acquired pes planovalgus in Transverse Plane?

Femoral antetorsion Internal femoral position Internal tibial torsion

Hubscher maneuver or great toe test of jack?

Forefoot to Rearfoot position Method of evaluating the flexibility of a pes planus or flat foot type. The test is performed with the patient weight bearing, with the foot flat on the ground, while the [clinician] dorsiflexes the [hallux] and watches for an increasing convexity [of the Arches of the foot].

deforming forces associated with acquired pes planovalgus in Frontal Plane?

Genuvalgum Forefoot varus

Silfverskiold test

Normal ankle dorsiflexion: - Ankle dorsiflexion with knee extended (= 10 degrees of DF) - With flexion of the knee additional 10 deg of DF (= 20 deg of DF) If dorsiflextion increases when knee is bent, pathology is coming from gastroc

Tibial Torsion, what is normal?

Normal malleolar angle of 0 at birth (5-8 by age 1) 9 degrees by 18 months and increasing 2 degrees to 18 at age 7

Morton's syndrome

Pinched nerve (usually between 3rd and 4th toe); treated with anti-inflammatory medication

Surgical Procedures for Pediatric Flatfoot

Tendon Achilles Lengthening Gastrocnemius Recession Evan's Procedure Arthroereisis

Evan's Procedure

The Evans technique is a surgical procedure to treat the mechanical instability of the lateral ankle ligaments. In the Evans procedure, the peroneus brevis muscle is separated from its musculotendinous compound and its proximal end is sutured to the peroneus longus. Then, an aperture is created from the postero-superior side of the fibula to the lateral malleolar tip. The tendon is then passed from the anterior side towards the posterior side through this aperture and sutured on itself. This procedure was designed to prevent talar tilt by reducing foot inversion and deterring chronic ankle instability.