Diseases of the foot. Rozkydal. Z.

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1 Diseases of the foot Rozkydal. Z.

2 Anatomy Art. talocruralis Art. talocalcanearis Art. Choparti Art. Lisfranci Art. metatarsophalangealis Art. IP proximalis Obr. 1 Art. IP distalis

3 Anatomy Art. talocruralis Art. talocalcanearis Art. Choparti Art. Lisfranci Art. metatarsophalangealis Art. IP proximalis Art. IP distalis Obr. 2

4 Obr. 3 Anatomy

5 Anatomy Obr. 4

6 Anatomy Obr. 5 Vaginae mm. extensorum pedis

7 Anatomy Obr. 6 Vaginae mm. peroneorum

8 Anatomy Obr. 7 Vaginae mm. flexorum pedis

9 Obr. 8 Aponeurosis plantaris Anatomy

10 Obr. 9 Flexors Anatomy

11 Obr. 10 Flexors Anatomy

12 The ankle joint Synovialitis Osteoarthrosis Trauma Posttraumatis conditions Static deformities Congenital deformities Rheumatoid arthritis Osteochondrosis dissecans - talus Stenosing tenosynovitis Tarsal tunnel syndrom

13 Synovialitis

14 Lateral ligaments prain artial rupture omplete rupture Obr. 12 Lig. collaterale lat.

15 Obr. 13 X- ray

16 Management Sprain: bandage, othesis Partial rpt.: orthesis, plaster Complete rpt.: suture and plaster Obr. 14

17 Chronic instability Obr. 15 Evans plasty Watson Jones plasty

18 Osteochondrosis dissecans tali Obr. 16

19 Arthritis of the ancle joint Obr. 18

20 Arthrodesis Adams- Horwitz arthrodesis Charnley arthrodesis

21 Total ankle replacement Obr. 21

22 Tarsal tunnel syndrom Obr. 22 Obr. 23

23 Tarsal tunnel syndrom Innervation of plantar side

24 Peroneal tenosynovitis

25 Pes planus- flat foot Congenital flat foot Rigid: Vertical talus Tarsal coalition Flexible: pes calcaneovalgus Vertical talus

26 Acquired flat foot Flat foot Laxicity Marfan sy, Ehlers- Danlos sy, Down sy Cerebral palsy, myopathies Rheumatoid arthritis

27 Flat foot 1. Diminished arch 2. No arch 3. Arch convex plantarwards Valgosity of the heel

28 3. degree flat foot Flat foot

29 In small children - pes planovalgus 3-6 years Weak muscles of the calf Valgosity of the heel Talus is medialy and plantarwards Subluxation of navicular bone

30 In small children - pes planovalgus Symptoms: Asymptomatic Fatique Contractures of the muscles Pain in the calf

31 Management stage Exercise Good shoes Firm heel Barfoot walking Not to overload Stretching of m. triceps surae

32 Management 3. stage Supports

33 Can lead to the flat foot Os tibiale externum

34 Tarsal coalition Peroneal spastic flat foot

35 Diminished weight bearing Good shoes Physiotherapy Supports Surgery- triple arthrodesis Flat foot in adults

36 Transverse flat foot Normal arch of metatarsal heads Arch of metatarsal heads in transverse flat foot

37 Pes transversoplanus Prominence of metatarsal heads Callosities

38 Types of the foot a quadratic b greece c egyptian Obr. 50

39 Transverse flat foot

40 Management Diminished weight bearing Good shoes Physiotherapy Supports Surgery

41 Weil osteotomy

42 Surgery Obr. 53 Wolf osteotomy Helal osteotomy

43 Resection of metatarsal heads

44 Hallux valgus- bunion

45 Surgery Soft tissues Osteotomies Resection arthroplasty Arthrodesis Joint replacement Obr. 61

46 Mc Bride procedure

47 Osteotomy of the first metatarsal Chevron osteotomy

48 Osteotomy of the first metatarsal Obr. 64 Scarf osteotomy

49 Op. sec. Lapidus

50 Proximal osteotomy of the first metatarsal

51 Op. sec. Keller resection arthroplasty Obr. 67 Obr. 68

52 Arthrosis art. MTPh. I. Hallux rigidus

53 Artrodesis of the big toe

54 Artrodesis of the big toe Obr. 69 Obr. 70

55 Replacement of the first metatarsal joint

56 Deformities of the foot Pes varus Pes valgus Pes cavus Pes equinus Pes calcaneus Pes equinovarus Obr. 73

57 Triple arthrodesis Ryerson Obr. 74

58 Triple arthrodesis- modifications Obr. 75 Dunn Obr. 76 Hoke

59 Triple arthrodesis Obr. 77 Lambrinudi

60 Pes equinus- drop foot Obr. 78 Obr. 79

61 Correction of the drop foot by triple arthrodesis Obr. 80

62 Triple arthrodesis for pes cavus Preop. Postop.

63 Tripple arthrodesis - pes equinovarus Talipes clubfoot

64 Correction of deformity of the foot in children Grice extraarticular arthrodesis

65 Prolongation of Achillis tendon Obr. 88 Vulpius Obr. 89 Strayer

66 Deformities of the toes mallet toe flexed toe flexed DIP joint

67 Mallet toe- dig. hamatus

68 Dig. superductus

69 Aseptic necrosis of bones m. Köhler I. m. Köhler II. m. Haglund- Sever Osteochondropathy of sesamoid bones

70 Bursitis and entesopathies Achillodynia Calcanear spur Haglund exostosis Os tibiale externum

71 Calcanear spur

72 Accesory bones Obr. 97 Os tibiale externum Obr. 98 Os trigonum

73 Plantar fibromatosis

74 Morton neuralgia

75 Unquis incarnatus

76 Diabetic foot 7-15 % diabetics Diabetic neuropaty Ischemic disease of lower Extremity Diabetic microangiopaty Obr. 100

77 Diabetic foot Charcot neuropatic joints

78 Diabetic foot Ulcers Necrosis

79 Management Team work Regular f/up Insulin -therapy Desinfection Proteolytic agents Antibiotics Vasodilatancia, vit E Angioplasty Bypass Hyperbaric chamber Immobilisation Arthrodesis Amputation (15 %)

$Stress fractures Synovitis of MTPh joints Sesamoid bone problems Tumors$

80 Other causes of pain in the foot Neurogenic: sciatica, spinal stenosis Vascular: varixes chronic venous insuficiency, ischemic vessel disease Stress fractures Synovitis of MTPh joints Sesamoid bone problems Tumors Inflammations: pyogenic, R.A., psoriatic, gout Tenosynovitis Neurogenic artropathies

Foot & Ankle Disorders

Foot & Ankle Disorders Hillingdon PGMC 6-7-2013 Htwe Zaw FRCS (Tr&Orth) Consultant Foot & Ankle and Trauma Surgeon Hillingdon Hospitals NHS Foundation Trust Overview Anatomy: hindfoot-midfoot coupling