Dropfoot - Video Gait Analysis - Craig A. Camasta, DPM, FACFAS Atlanta, Georgia, USA

Transcription

1 Equinus, Pes Cavus and Dropfoot - Video Gait Analysis - Craig A. Camasta, DPM, FACFAS Atlanta, Georgia, USA

2 Equinus = Toe Walker Soft Tissue Static fixed contracture Dynamic spastic, hypertonic Bone Procurvatum,, Post-Traumatic Remodeled / Arthritic Post-Contracture Location Leg, Ankle, Foot Bone v. Soft Tissue v. Combination

3 Cavus = High Arch Forefoot Plantarflexed on Rearfoot Normal Ankle ROM Familial Tendency Inherited Neuromuscular Dx (Charcot-Marie-Tooth)

4 Dropfoot Weak Dorsiflexion Nerve Injury CVA Crush/Laceration Neuromuscular Dx CMT

5 Equinus vs. Cavus Equinus = Ankle or Above Cavus = Below Ankle

6 Pes Cavus = Forefoot Equinus Pseudo Equinus

7 Dropfoot (spinal injury)

8 Dropfoot + Equinus (CMT)

9 Dropfoot - CP Nerve Injury Pre TPTT/STJ Fusion

10 Gastrocnemius Equinus Contracture Crosses Knee Tight With Knee Extension Gastro-Soleal Tight With Knee Flexion Static vs. Hypertonic/Spastic Clonus Hyper-reflexia reflexia

11 Equinus Assessment

12 Testing For Equinus Observation Stance & Gait Manual Assessment TEST WITH FOOT NEUTRALIZED 1. Reduce Deformity & Maintain Position 2. Dorsiflex Forefoot While Pulling Down Heel Hubshire Maneuver Patient may need to step forward Toe Raise Heel Inversion? Arch Reduction?

13 Neutralized Dorsiflexion

14 Neutralized Dorsiflexion

15 Hubshire & Toe Raise

16 Hypertonia & Equinus

17 Heel Cord Lengthening When is it INDICATED? Heel Pitch Inclined Never Indicated Heel Pitch Flat or Declinated Always Indicated

18 TAL vs. Gastroc Recession TAL GastroSoleal Equinus Long-standing Deformity Severe Contracture Older Patients Gastrocnemius Recession Gastrocnemius Equinus Lesser Degree of Equinus Young Patients Easier Recovery

19 TendoAchilles Lengthening Many Approaches Tenotomy Open or Percutaneous Percutaneous Series of Stabs 18 Ga. Needle Open Frontal Z Controled Length

20 Gastroc Recession Many Approaches Limited Open Tenotomy Contained System Open Tenotomy Tongue / Groove

21 Compensation Ability of Limb to Accommodate Deformity Available ROM Plane of Deformity Sagittal primary Transverse & Frontal secondary Beyond Available ROM RESIDUAL DEFORMITY

22 Equinus Compensation Fully-Compensated Heel Contacts Ground UnCompensated Heel Floating

23 Compensated Equinus Pes Valgus Hammertoes / HAV Genu Recurvatum Increased Pressure Forefoot Diabetic Trophic Ulcers

24 Foot Compensation Pes Planovalgus - Hammertoes / HAV

25 Foot Compensation Diabetic Ulcers

26 Foot Compensation Neuropathic - Charcot Arthropathy

27 Manual Reducibility Eliminate Equinus

28 17 F Clubfoot Sx Age 1

29 17 F Clubfoot

30 17 F Clubfoot

31 Equinus: : Stance & Gait Compensated Equinus Pes Planovalgus / Abducted Gait Early Heel-Off Forward Leaning Posture / Genu Recurvatum Prolonged Limb Support in Gait Lack of Full Knee Extension in Gait

32 Compensated Equinus

33 Stance / Posture

34 Gait Analysis

35 Compensated Equinus : Genu Recurvatum

36 Gait - Compensated Equinus

37 Compensated (?) Equinus Comfort Forced Stance POY 6 POY 3 TAL

38 Equinus-Compensated Flatfoot 7 / F Severe Pes planovalgus / Vertical Talus

39 Compensated Equinus Gait - CVA

40 Equinus-Compensated Flatfoot

41 Gait - Compensated Equinus

42 Equinus Flatfoot PO Y2 TN Fusion / TAL

43 Equinus Flatfoot Gait

44 Gastroc / Evans / Medial Arch

45 9 yo F Equinus / Vertical Talus

46 TAL & Spring Ligament Plication

47 Young s Tenosuspension

48 TAL Repair + Result

49 Pre and Post Reduction of Equinus

50 Spastic Equinus & Gait

51 Spastic Equinus M Gravis

52 Spastic Gait Pre-Op Post-Op TA, TP, Achilles

53 Compensated Equinus - MVA

54 Equinus: : Stance & Gait UnCompensated Equinus Pes Equinus or EquinoVarus or EquinoAdductoVarus Increased Angle & Base Residual Knee Flexion Lateral Ankle Instability Circumductory Gait Shortened Limb Support in Gait LLD longer leg Combination Deformities Talipes equinovarus = clubfoot

55 Bony Equinus Residual Deformity

56 Uncompensated Equinus Pes Valgus

57 Gait - Uncompensated Equinus

58 Spastic Equinus - CVA

59 23 Year Post MVA, CP Nerve Paralysis, Dropfoot Equinovarus

60 Post-Op TAL / AJC

61 Pre and Post Gait

62 Pre and Post With Shoe

63 Uncompensated Equinus Brain Tumor Pre-Op X-Ray Post TAL/AJC

64 Pre and Post Pan Talar Arthrodesis

65 Before & After

66 Uncompensated Equinus Gait Before After

67 Uncompensated Equinus 1.5 Year Post MVA, Talus AVN, Flap/Graft

68 Pre and Post - TAL/AJC, PanTalar Arthrodesis

69 Pre and Post Y 1 & Gait

70 Equinus - Surgical Principles Assess Bone & Soft Tissue Staged Approach TAL, AJC Bone Resection One Stage More Bone Resection Loss Limb Length

71 52 M Equinus + Cavus

72 Gait Analysis Equinus? Pes Cavus? Dropfoot??? Combination Deformity

73 Equinus Gastrocnemius or GastroSoleal Assess With Foot NEUTRALIZED TAL vs. Gastroc Recession Compensated Heel on Ground Uncompensated Toe Walker

74 Dropfoot & Equinus & Cavus All Limited Dorsiflexion Dropfoot Weakness of Dorsiflexion Equinus Primary Deformity At / Above Ankle Compensation Above (genu( recurvatum) ) & Below Ankle (pes( valgus,, HAV, HT) Cavus Primary Deformity Below Ankle (foot) Compensation Distal (toes) & Proximal (ankle)