Flatfoot Reconstruction for Spastic Foot Deformity



Flatfoot Reconstruction for Spastic Foot Deformity


Colyn J. Watkins





  • Lateral column lengthening and medial plication with possible medial cuneiform osteotomy is our operation of choice in the mild to moderate neuromuscular flatfoot deformity (Gross Motor Function Classification System [GMFCS] I/II)


  • Lateral column lengthening with talonavicular (TN) fusion with possible medial cuneiform osteotomy is our operation of choice in the severe neuromuscular flatfoot deformity (GMFCS III/IV/V)


Operative Indications



  • Feet that can no longer be braced effectively


  • Lever arm dysfunction in ambulatory children


  • Pain and medial skin breakdown


Preoperative Evaluation



  • Anteroposterior (AP), lateral, and oblique weight-bearing films of the affected foot


  • Preoperative examination should focus on evaluation of flexibility of the foot and evaluate for presence of ankle valgus. If there is concern for true ankle valgus, a weight-bearing AP and lateral image of the ankle should be obtained


  • Careful examination of the hip, knee, and ankle in concert is necessary


  • Dose surgery according to functional level


  • Assess gastrosoleus complex tightness with the hindfoot locked in neutral to slight varus; be aware of midfoot break when examining for calf tightness


  • In the TN neutral position, assess the midfoot for the presence of supination as residual supination will increase the risk of recurrence



Positioning



  • Supine with bump under ipsilateral buttock, which can be removed when operating on the medial side








Lateral Column Lengthening

Jun 9, 2022 | Posted by in Reconstructive surgery | Comments Off on Flatfoot Reconstruction for Spastic Foot Deformity
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