Hallux valgus causes warts traduction

Here an incision in line with the peroneal tendons is made over the lateral aspect of the foot.Positive test indicates torn ant talo-fib lig( major restraint to anterior shift) Talar tilt test- similar positon - ankle 10 deg PF, slight IR, palpate jt line as do test, compare with other side.There are several theories as to the cause of clubfoot.Portal is created with an arthroscopic ACL drill guide and guide wire under arthroscopic control- can make a ~ 5 mm portal if required -problem- creates a defect in articular cartilage Supine , Tourniquet , distraction with device optional [ Back to the Top ]Longitudinal ant approach, just lat to ant NV bundle, subperiosteal exposure of bone Mark tibia to ensure correct alignment cut tibia first talus cut next- parallel to distal tibial cut articular surfaces of the malleoli + med and lat surfaces of talus bared with burr or saw or osteotome position talus under tibia in desired alignment cannulated screw fixation- 2 guide wires placed retrograde through cut tibial surface to emerge through posterior tibial cortex, one medial and one lat to tendo achilles- these should diverge slightly through the tibia- they will then converge in the talus.In mild clubfoot there are slight changes in the structure of the foot; more severe cases involve orthopedic deformities of both the foot and leg. It may have an abnormally high longitudinal arch (talipes cavus) or it may be in dorsiflexion (talipes calcaneus), in plantar flexion (talipes equinus), abducted and everted (talipes valgus or ), adducted and inverted (talipes varus), or various combinations of these (talipes calcaneovalgus, talipes calcaneovarus, talipes equinovalgus, or talipes equinovarus).A familial tendency or arrested growth during fetal life may contribute to its development, or it may be caused by a defect in the ovum.The peroneal tendons are identified and an opening osteotomy performed in the line of the tendons and then packed with graft. Then via dorsal incision in 1st web release of the contracted structureson the lat side or: a distal osteotomy e.g.A BK walking cast is applied for six to eight weeks. The post tibial artery + vein and tibial nerve lie between the fibrous septae that separate the tendons of FDL and FHL- the tarsal tunnel.Positive test indicates torn ant talo-fib and calcaneo-fib ligs (Almost impossible to injure the calcaneo-fib lig alone - the ant talo-fib lig is torn first, then the calcaneo-fib lig, rarely then the post talo-fib lig- finally the ankle would then dislocate) Ultrasound ankle arthrography/peroneal tenography: the ant talofib lig is a capsular lig- tear will show dye leakage the calcaneo-fib lig is extracapsular and closely related to the peroneal sheath - tear will show dye leaking into peroneal sheath on ankle arthrography, or leakage of dye into jt on peroneal tenography MRI- demonstrates tears but other tests are less expensive- thus indications limited functional treatment for acute injuries ( only indication for operative reconstruction acutely is in the high demand sports person) If residual problems of instability despite program of exercises and strapping or use of a splint, then reconstruction indicated Procedure used not critical- results good/ excellent ~ 85% for all- options are: - late direct repair of the torn ligs (Brostrom) - augmented reconstruction eg peroneus brevis (Evans, Watson-Jones) Primary repair of the lateral ligament is rarely indicated and greater than 85% require no further treatment (results of early repair no better than delayed).(Dwyer described a medial opening wedge for persistent calcaneovarus deformity) Congenital flat foot (vertical talus) requires reduction of the displaced talus involving ETA and medial release to reduce the talus and possible also a lateral release and ' K' wire fixation followed by POP casting Tight heel cords may need to be stretched or lengthened if resistant [ Back to the Top ] common, often missed Pain, swelling behind med malleolus later the talonavicular and subtalar jts collapse, hindfoot drifts into valgus, midfoot pronates and the forefoot abducts in the late stage pain from ST jt degeneration, abutment of the os calcis against the fibula Early: NSAID, support with an orthosis-a period in a BK POP may help to relieve the synovitis Later: a caliper with outside bar and inside T-Strap helps prevent deformity Surgery: is indicated if symptoms persist or are severe if no fixed deformity- exploration , synovectomy +/- transfer of FDL or FHL fixed deformity: fusion [ Back to the Top ] Everted foot associated with peroneal muscle spasm but not produced by muscle imbalance The syndrome consists of a painful, rigid valgus deformity of both the fore and hind parts of the foot and peroneal muscle spasm but not true spasticity Often associated with calcaneo-talar or calcaneo-navicular bars (tarsal coalition) with a faulty pattern of movement in the subtalar joint producing pain and muscle spasm Tarsal coalition in the foetus occurring as a result of failure of differentiation and segmentation of primitive mesenchyme May also occur in inflammatory conditions such as Reiters disease and other inflammatory arthropathies when there is involvement of the subtalar joint Usually 12 - 16 years at presentation Males : Females 2:1 Often bilateral Calcaneo-navicular and middle facet talo-calcaneal coalitions are the most common ? May be secondary to pressure from outside the tunnel ( eg displaced #'s of tibia, talus or os calcis, tenosynovitis or ganglia of the adjacent tendon sheath) or within the tunnel ( eg varicosities, neural tumour) EMG studies show slowing of conduction Most ankle sprains occur in the 15 - 35 year old athlete.A 3rd wire is inserted in the midline ,~ 3 cm above the distal end of the cut tibia bones then reduced, all 3 wires advanced into talus (I-I control), measured, drilled, screwed graft packed into any spaces Has a high rate of complications particularly wound problems, talar collapse and loosening of components Due to the high complication rate and poor long term clinical results arthrodesis should be the first line treatment for the painful arthritic ankle regardless of the underlying pathological process 4 year follow up: talar collapse in 1/3 and loosening in 1/3 ROM usually poor (less than 30Not produced any significantly good results to date.Injury to the calcaneo-fibular ligament occurs in more severe injuries and disruption of the posterior talo-fibular ligament is rare Inspect for swelling palpate for tenderness over each ligament Anterior drawer test - knee flexed, ankle PF 10 deg,slight IR to relax deltoid lig, compare with other side.It sometimes accompanies meningomyelocele as a result of paralysis.

Injury to the anterior talo-fibular ligament is the most common and 97% of all ankle ligament ruptures occur on the antero-lateral side.ref: Kannus and Renstrom "Current concepts review: Treatment for acute tears of the lateral ligaments of the ankle" JBJS 73A:305-312, 1991 Marder "Current Methods for evaluation of ankle ligament injuries"JBJS 76A:1103,1994 Colville " Reconstruction of the lateral ankle ligaments" JBJS 76A: 1092, 1994 [ Back to the Top ] This occurs in a relatively hypovascular area of the tendon 2 - 6 cm above the insertion into the calcaneus probable due to repetitive micro trauma which causes an inflammatory reparative process which because of decreased vascularity is unable to keep up with the stress.Can also supplement with FDL, FHL, peroneus brevis skin slough rerupture adhesions stiffness of ankle with reduced dorsiflexion no significant functional difference bw operative and nonoperative rerupture rate 2-7% operative, 8-35% nonoperative ref : Carr and Norrish" the blood supply of the calcaneal tendon" JBJS 71B: 100-101, 1990 [ Back to the Top ] R/O loose bodies synovial bx and synovectomy evaluation, debridement, drilling or pinning osteochondral defects or #'s Irrigation/ debridement of septic arthritis of the ankle excision of osteophytes debridement of OA E/O soft tissue impinging lesions eg a meniscoid lesion investigationof ankle pain of unknown aetiology Arthroscopic assisted arthrodesis 3 anterior portals 2 trans malleolar portals for approaching osteochondritic lesions of the talar dome not accessible from any other portal.May only be indicated in pan-talar OA in order to maintain some movement after a triple arthrodesis.Most common in 3-5 decades, occurs during a forced dorsiflexion against a contracted heel cord or in sudden acceleration Acute-nonoperative- immob in POP in plantar flexion 8 wks, followed by a heel lift for another 2-3 mths Operative- posteromed skin incision -allows access to plantaris to augment repair, Suture (kessler/Bunnell with peripheral suture), repair paratenon separately Late repair of chronic rupture- difficult to approximate ends- can supplement repair with plantaris, fascia lata, a strip of fascia turned down from prox tendon.


harppylady93      
Poor wound healing is a problem Infection rate between 2% and 5% High loosening rate early.