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Flatfoot versus Talotarsal Displacement


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Flat feet are a common problem that traditionally have been ignored or treated with extensive surgery. It is possible that there is a dislocation of the ankle bone (talus) on the hindfoot bones leading to a misalignment. A new evidence-based procedure is available that is a real "game" changer. View this presentation to learn more.

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Flatfoot versus Talotarsal Displacement

  1. 1. Michael E. Graham, DPM
  2. 2. Objectives• What is a flatfoot?• What is talotarsal displacement?• Does it make a difference?
  3. 3. What is a “flat” foot? This can mean several things.
  4. 4. “Flat Foot” or “Fallen Arches”• Is a rather common Normal problem affecting pediatric, adults, and geriatrics.• The foot is misaligned• There is malalignment Not Normal of the hindfoot bones forcing a lowering of the natural arch of the foot.
  5. 5. What kind of “flat feet” are there? Not all misaligned feet are the same.
  6. 6. What are the choices? Flexible flat foot Semi-flexible flat foot Rigid flat foot
  7. 7. “Flexible” Flat Foot• There is an arch with no pressure on the foot. No Weight• Upon standing there is a loss of the height of the arch• The foot can be put Weight back into its “normal” position during standing.
  8. 8. Semi-Flexible Flat Foot• There isn’t much of an arch with or without pressure on the foot.• The foot flattens out more during standing• Cannot be put fully back into its “normal” position.
  9. 9. Rigid Flat Foot• The foot has no arch on or off the ground.• Cannot be manually forced back into it’s normal position on or off the ground.
  10. 10. Flat Feet- Who Cares? What difference does it make?
  11. 11. It makes a big difference to your quality of life.• The alignment and function of our feet plays a tremendous role in our ability to stand, walk, run, and exercise.
  12. 12. • When our feet are in “alignment” they are functioning as they were designed.• There is no excessive strain acting on the bones, ligaments, tendons, muscles, or the neurovascular structures.
  13. 13. Poorly Aligned Feet• Sooner or later a “problem” will develop at the “weakest link of the chain” and is a sign that something is wrong.• With every step taken excessive abnormal forces are acting on the supporting structures of the foot.• Average person takes 6,000 to 10,000 steps a day.
  14. 14. “Functional Symptoms”• Due to the chronic nature of this disease process (walking is the 2nd most common conscious function of our body) the individual finally realizes that: “The more active I am the worse my pain, the less active I am the pain isn’t so bad”
  15. 15. So then what happens?
  16. 16. We decrease our activity level.• If it hurts…don’t do it• We stay off of our feet and become lazy• We do whatever we can not to walk or stand because it simply gives us pain.• We suffer if we exercise so we don’t• Our metabolism decreases now the real problems begin……next slide please.
  17. 17. Decreased Metabolism• Body cannot burn off the calories• Increased weight gain• Obesity• Hypertension• Diabetes• Coronary Heart Disease• Syndrome X
  18. 18. “My feet are not properly positioned and they don’t bother me at all!” Are you sure about that?
  19. 19. No Symptoms Yet?• Imagine our foot acting as the tire on our car.• We can place the tire on our car without balancing it.• It functions great, what’s the big deal about balancing the tire.• Who cares!• Next slide please
  20. 20. Oops…I guess it does matter• Sooner or later it will wear out.• Not only is the tire affected but it can adversely affect the other tires.• The steering also becomes misaligned.
  21. 21. It is only a matter of time• Average person takes – 7500 steps a day• 50 years of age – 134,137,500 steps taken• This is not normal• Have you ever heard someone say: “I just turned fifty and it seems like my body is just falling apart” I wonder why?
  22. 22. Normal Alignment• This is what the hind foot alignment is supposed to look like.• Talus is sitting on top of the hind foot bones.• Sinus tarsi (natural Calcaneus spaced between the ankle & heel bone is in an “open” position.
  23. 23. Normal Hind-foot Mechanics (next slide please)
  24. 24. Abnormal Alignment• Talus is not sitting where it is supposed to be on the heel bone.• This partially collapses the sinus tarsi.• Partial talotarsal joint dislocation is present. Calcaneus• Excessively abnormal forces are acting on the foot.
  25. 25. Not Normal.• Complete collapse of the sinus tarsi.• Talus is not where it is supposed to be.• This person is suffering one way or another because of misalignment of the ankle bone.
  26. 26. Abnormal Hind-foot Mechanics next slide please
  27. 27. Talotarsal Displacement
  28. 28. There is a difference between a flat foot and talotarsal displacement?
  29. 29. The primary difference is:
  30. 30. A flat foot has a lower than normal calcanealinclination angle in additional to TTD.
  31. 31. Here is a patient who exhibitstalotarsal displacement who does not have a lower than normal calcaneal inclination angle.
  32. 32. Whyshould this be important to you?
  33. 33. Because it alters treatment options.
  34. 34. Doesn’t this seem aggressive?
  35. 35. This patient did not have a flat foot, the calcaneal inclination angle is normal.Why couldn’t a EOTTS procedure be performed?
  36. 36. Why not try internal, extra-articular, extra-osseousstabilization?
  37. 37. What can EOTTS Achieve? Sagittal Plane Correction
  38. 38. What can EOTTS Achieve?Transverse Plane Correction
  39. 39. EOTTS does not have an effect on the calcaneal inclination angle! AFTER EOTTS Procedure BEFORE
  40. 40. To correct a lower than normal Calcaneal Inclination Anglecalcaneal osteotomy is required.
  41. 41. Don’t assume that your patientsimply has a flatfoot and that the only option is traditional reconstructive surgery
  42. 42. There are easier option for TTD.
  43. 43. Refuse to ignore or cover-up your misaligned feet.