adult aquired flatfoot

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

SINGLE LIMB HEELRAISE

FIXED FOREFOOT VIRUS

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

ANTEROPOSTERIOR XRAYS

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