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Adult aquired flatfoot

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Adult aquired flatfoot

  1. 1. ADULT AQUIRED FLAT FOOT DR. MANOJ R. KANDOI M.S,FICS, DORTHO,DNB
  2. 2. • I AM THANKFUL TO MY TEACHER DR. SANZEORGAN, UNIVARSITY OF WASHINGTON
  3. 3. AND ALSO TO DR. SIGWARD T. HANSEN ,FOOT CLINIC, HARBORVIEW MEDICAL CENRE SEATTLE
  4. 4. ADULT AQUIRED FLAT FOOT• IT DEVELOPS ONCE SKELETAL MATURITY IS REACHED• IS DIFFERENT FROM CONSTITUTIONAL WHICH IS PRESENT SINCE BIRTH
  5. 5. FLAT FOOT
  6. 6. LAT VIEW
  7. 7. CAUSES• POSTERIOR TIBIAL TENDON DYSFUNCTION• FRACTURE AND DISLOCATION• TARSAL COALITION• NEUROARTHROPATHY• NEUROLOGICAL WEAKNESS• IATROGENIC CAUSES
  8. 8. CAUSES OF TIB. POST DYSFUNCTION• DEGANERATIVE• INFLAMMATORY:R.A.,SERONEGATIV E SPONDYLOARTHROPATHY• TRAUMATIC
  9. 9. PATHOPHYSIOLOGYSUPPORT OF MEDIAL LONGITUDINAL ARCH:1)STATIC (PLANTAR FASCIA,LONG AND SHORT PLANTAR LIGAMENT,SPRING LIGAMENT2)DYNAMIC(TIBIALIS POST.WHICH CAUSES INVERSION OF MIDFOOT AND ELEVATION OF ARCH AND INDIRECTLYHINDFOOT INVERSION)
  10. 10. 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
  11. 11. SIGNS• EXAMINATION IN STANDING POSITION WITH BOTH FOOT COMPARED• EARLY STAGE, SWELLING ALONG POST. TIBIAL TENDON SEEN• ARCH IS LOWERED• FOREFOOT IS ABDUCTED
  12. 12. TOO MANY TOES SIGN
  13. 13. SINGLE LIMB HEELRAISE
  14. 14. FIXED FOREFOOT VIRUS
  15. 15. OTHER EXAMS• TENDOACHILLES CONTRACTURE SHOULD BE LOOKED FOR IN KNEE FLEXION AND EXTENSION• LOOK FOR TENDERNESS & IMPINGEMENT AT SINUS TARSI AND DISTAL FIBULAR AREA
  16. 16. LAB. INVESTIGATIONS• CBC , ESR• RA TEST• HLAB27• FBS TO R/O SENSORY NUROPATHY
  17. 17. STANDING LATERAL XRAYSOF PTT DYSFUNCTION
  18. 18. ANTEROPOSTERIOR XRAYS
  19. 19. Stages of PTT dysfunctionSTAGE1:• PERITENDINITIS AND TENDON DEGENERATION• TENDON LENGTH NORMAL• PAIN & SWELLING ALONG TENDON SHEATH
  20. 20. STAGE 2• LENGTHENING OF PTT• CORRECTIBLE FLAT FOOT DEFORMITY• DEFORMITY ON WEIGHTBEARING• HINDFOOT AND MIDFOOT DEFORMITY CAN BE PASSIVELY CORRECTED TO NEUTRAL
  21. 21. STAGE 3• FIXED HINDFOOT VALGUS• RIGID FLATFOOT
  22. 22. STAGE 4• DELTOID LIGAMENT ELONGATES• VALGUS TILT OF TALUS IN ANKLE MORTISE
  23. 23. PA VIEW
  24. 24. DISTRACTION ARTHRODESISOFCALCANEOCUBOID JOINT
  25. 25. THANK YOU

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