DOCSLIB.ORG

Addressing Hallux Valgus in the Metatarsus Adductus Foot Type

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Addressing Hallux Valgus in the Metatarsus Adductus Foot Type CHAPTER 1 Addressing Hallux Valgus in the Metatarsus Adductus Foot Type William D. Fishco, DPM INTRODUCTION there is not much of an increased intermetatarsal angle due to the varus deformity of the lesser metatarsals. Metatarsus adductus is a congenital foot deformity When a patient presents to the offi ce with a chief complaint characterized by a uniplanar deformity where the metatarsals of a bunion, and after the work-up there is signifi cant are angulated at the Lisfranc’s joint causing adduction of the metatarsus adductus, surgery options really have be carefully forefoot in relation to the midfoot and hindfoot (1). The implemented. Unless there is severe dysfunction of the foot, occurrence of metatarsus adductus has been reported to be pan metatarsal osteotomies are not typically recommended. 1 to 2 cases per 1,000 (2,3). Metatarsus adductus is the most However, your typical “go to” bunionectomy may not be the common congenital foot deformity in the newborn (3) with best option. For example, if you typically perform an Austin a male predilection as high as 80% (2). Fetal constraint is the bunionectomy or equivalent (distal metaphyseal osteotomy), most common cited etiologic factor with compression of it will likely yield a poor outcome with failure to correct the the forefoot with the legs crossed across the body (2). deformity and/or rapid recurrence of deformity. Decision- Obvious congenital deformities such as calcaneovalgus making and procedural selection becomes more intense. and talipes equinovarus (clubfoot) are quickly identifi ed Expectations of the surgery need to be clearly communicated at birth and treated appropriately. Since there are no to your patient as the typical result of “bump gone toe standard foot screening methods or protocols of newborns straight” is not likely achievable. for minor deformities such has metatarsus adductus, these We are familiar with evaluating the intermetatarsal go untreated and will surface as problems later in life. As angle on an anteroposterior radiographic view. If you, in clinicians, we see metatarsus adductus in older children and part determine your procedure based on that criterion, adults on a regular basis, confi rming the lack of recognition then remember to calculate the true intermetatarsal angle, at infancy. which is the intermetatarsal angle plus (metatarsus adductus The metatarsus adductus foot type is associated with a angle minus 15 degrees). For example, if the intermetatarsal number of clinical challenges for the podiatrist. Some of the angle measures 8 degrees and the metatarsus adductus angle common pathologies include Jones fractures, pain due to measures 25 degrees, then the true intermetatarsal angle is the prominence of the fi fth metatarsal base, premature non- 18 degrees, 8+(25-15)=18. An Austin bunionectomy may be traumatic arthrosis of the second and third tarsometatarsal appropriate for an 8-degree intermetatarsal angle; however, joints, lateral column foot pain, and severe bunion a bunion deformity with an 18 degree intermetatarsal angle deformities. When metatarsus adductus is seen in the high will typically need another type of correction. arched foot, pathologies worsen and treatment is even more The following list will include some pearls to remember demanding and challenging. These feet are associated with when addressing large bunion deformities with underlying lateral ankle instability, chronic peroneal tendinopathies, metatarsus adductus deformity: dorsal tarsal metatarsal joint exostoses with or without • Set realistic expectations. Always discuss the two peroneal nerve irritation, and chronic dorsolateral foot deformities that you are treating or dealing with, pain (lateral column overload) (4). Often, just fi xing a metatarsus adductus and hallux valgus. Explain to ligament or tendon may not address the global problem your patient that you are limited to the amount of the pes cavus deformity. To that end, in addition of “straightening” of the fi rst metatarsal bone by to addressing the ligament or tendon, a cavus foot the patient’s anatomy. Even though pain should reconstruction may be prudent. resolve and the foot will clinically look better, there will still be a residual bunion and the toe will not SURGICAL MANAGEMENT be straight. I typically show them that all of their toes deviate laterally due to the medial drift of the The surgical management of hallux valgus in the metatarsus metatarsal bones. Remember the toes move in the adductus foot type is one of the most challenging surgical opposite direction of the metatarsals. scenarios that we have to deal with. Clinically, the bunion • Avoid distal metatarsal osteotomies. I am always deformity always looks worse than the radiograph. Often, more aggressive in correction by doing a base 2 CHAPTER 1 wedge osteotomy or a Lapidus. This is the case advanced long-standing deformity, remember to in juvenile hallux valgus and with underlying consider a fi rst MTPJ fusion. metatarsus adductus. You will sometimes need to • Pick your battles. Let’s face it, we are surgeons and slightly overcorrect your bunion correction. You are we fi x things. There is nothing wrong with being less likely to get a varus deformity in the metatarsus honest with your patient telling them that unless foot type with a slightly negative intermetatarsal they can’t live with it…they should just live with it. angle than in the rectus foot type. As you know, most patients think a bunionectomy is • Consider an Akin. It is diffi cult to get a straight toe a simple procedure where you shave the bump and after the metatarsal work is done. Clinically it helps call it a day. After a thorough review of what would with appearance. need to be done to fi x the problem appropriately, • Consider a second and third metatarsal osteotomy the best answer may be wearing wider shoes and if the deformity is mostly of the medial three using pads/cushions. If you are both up to the metatarsals, which is quite common. After the challenge and investment of time and energy, second and third metatarsals have been shifted then fi ne, do the surgery. Otherwise, there is no laterally, now you have more room to get the fi rst harm in treating it conservatively. I tell my patients metatarsal over. You can then do a Lapidus, Scarf, “Bunions won’t kill you, they just make you suffer or base-wedge osteotomy. a little.” • Consider a fi rst metatarsophalangeal joint (MTPJ) fusion when there is an element of degenerative CASE REPORTS joint disease or if you are considering a pan metatarsal head resection in a severe case of laterally The fi rst case is in a 14-year-old girl, who was active with windswept toes. You can be assured that when the cheerleading and volleyball. She presented with the chief fusion is done, the toe is not going to laterally drift complaint of a painful bunion deformity. Evaluation of her and you will not loose correction. A fi rst MTPJ anteroposterior radiograph revealed moderate metatarsus fusion should always be on your radar screen for adductus with a bunion deformity (Figure 1). I knew an a “jumbo” bunion deformity. We have all seen Austin would not hold up in the long run. I chose to do recurrence of a bunion with a Lapidus due to a closing base-wedge osteotomy. When you look at the splaying at the intercuneiform joint, however, you postoperative radiograph, you will notice a slight over will be hard pressed to fi nd a recurrence of a bunion correction of the intermetatarsal angle (Figure 2). In order after a fi rst MTPJ fusion. In the older patient with to get a congruous joint, you will need to do that at times. Figure 1. A 14-year-old female with moderate Figure 2. View of a closing base wedge osteotomy of bunion deformity with underlying metatarsus the fi rst metatarsal. Note the slight over-correction adductus. of the intermetatarsal angle. CHAPTER 1 3 Figure 3. View of a 24-year-old Figure 4. Postoperative view female with metatarsus adductus after a Lapidus bunionectomy. and bunion deformity. Note the slight negative intermetatarsal ankle. Figure 5. Radiographic view of Figure 6. View after second and a 62-year-old female with severe third metatarsal osteotomies with a metatarsus adductus deformity. Lapidus bunionectomy. A 24-year-old female presented to the offi ce wanting her 4). By doing this, I was able to get a congruous joint, which bunion fi xed. Her pain was on the “bump” and she had trouble should give long-lasting correction. wearing dress shoes, which were necessary for her work. A 56-year-old female presented to the offi ce with severe Radiographs revealed a metatarsus adductus with a moderate deformity of her left foot. She was having trouble wearing bunion deformity (Figure 3). Again, this is a case where an conventional shoes and was wearing mostly slipper type Austin bunionectomy is not going to give you the correction shoes. She stood all day sorting mail in a US postal service that you need. I chose to do a Lapidus bunionectomy. Notice mailroom. Radiographs revealed severe metatarsus adductus the slight over-correction of the intermetatarsal angle (Figure deformity with mid-foot arthrosis (Figure 5). This is one of 4 CHAPTER 1 Figure 7. Radiograph of a 74-year-old Figure 8. Radiograph after a male with long-standing deformity. second and third metatarsal osteotomy with arthrodesis of the fi rst metatarsophalangeal joint. Note the improved position of the second and third toes. Figure 9. Preoperative radiographs Figure 10. Postoperative radiograph. of a 40-year-old female with a large hallux valgus deformity with metatarsus adductus affecting mostly the medial 3 metatarsals. those very challenging cases where one has to consider a not have any midfoot pain where she had arthrosis of the major reconstruction.
Load more

Recommended publications
  • Loss of Correction in Cubitus Varus Deformity After Osteotomy
    Loss of correction in cubitus varus deformity after osteotomy Chao You Shenzhen children's hospital Yibiao Zhou Shenzhen children's hospital https://orcid.org/0000-0001-9754-1089 Jingming Han ( [email protected] ) Research article Keywords: cubitus varus osteotomy Loss of correction Posted Date: May 5th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-26279/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Purpose Cubitus varus deformity in the pediatric population is an infrequent but clinically important disease to orthopedic surgeons. Since these patient populations are different in many respects, we sought out to investigate the rates of loss of correction over time as well as the factors associated with loss of correction in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity. Methods Between 2008-7 and 2017-7, we treated 30 cases of cubital varus had underwent the the osteotomy. We compared preoperative and postoperative clinical and imaging parameters (H-cobb angle,Baumman angle) for all patients. Postoperative evaluation was performed by telephone interview. Results In our study,there were 30 patients,included 17 males and 13 females.the mean age was 75 months old.In the rst follow-up,Approximately 80 % of patients had a loss of correction of H-cobband 83% of patients at the second follow-up. The Baumann angle also had a loss of correction,about 57% was lost at the rst follow-up,and 43% was lost at the second follow-up. The average interval between the rst follow-up and the second follow-up was 24 days The H-cobb angle mean loss was 2.4°.There was a statistically signicant difference between the H-cobb angle measured before surgery and the angle measured after surgery (p <0.05).
    [Show full text]
  • Angular Limb Deformities in Foals: Treatment and Prognosis*
    Article #4 CE Angular Limb Deformities in Foals: Treatment and Prognosis* Nicolai Jansson, DVM, PhD, DECVS Skara Equine Hospital Skara, Sweden Norm G. Ducharme, DVM, MSc, DACVS Cornell University ABSTRACT: This article presents an overview of the clinical management of foals with angular limb deformities. Both conservative and surgical treatment options exist; the choice of which to use should be based on the type, severity, and location of the deformity as well as the age of the foal. Conservative measures include controlled exercise, rigid external limb support, and corrective hoof trimming. Surgical treatment modalities comprise tech- niques for manipulating physeal growth and, after physeal closure, various corrective osteotomy or ostectomy methods. The prognosis is generally good if treatment is initi- ated well in advance of physeal closure. ngular limb deformities and their treat- Conservative Treatment ment in foals and young horses constitute In most foals born with mild to moderate a significant part of the orthopedic prob- angular deformities, spontaneous resolution A 2 lems that veterinarians must manage. This article occurs within the first 2 to 4 weeks of life. In discusses the clinical management and prognosis newborn foals, periarticular laxity is the most of these postural deformities. likely cause, and these foals require no special treatment other than a short period of con- TREATMENT trolled exercise. In our opinion, mildly and The absence of controlled studies has moderately affected foals should not be confined impaired the accumulation of scientific data to a stall because exercise is important for nor- guiding the management of angular limb defor- mal muscular development and resolution of the mities in foals (Table 1).
    [Show full text]
  • Knee Arthroplasty in Patients with Rheumatoid Arthritis
    Ann. rheum. Dis. (1974), 33, 1 Ann Rheum Dis: first published as 10.1136/ard.33.1.1 on 1 January 1974. Downloaded from Knee arthroplasty in patients with rheumatoid arthritis B. BLUM,* A. G. MOWAT, G. BENTLEY, AND J. R. MORRIS Rheumatology Unit, Nuffield Departments ofMedicine and Orthopaedic Surgery, University ofOxford, Nuffield Orthopaedic Centre, Oxford MacIntosh metallic tibial plateau prostheses have based upon the failure of conservative therapy mani been used in the Nuffield Orthopaedic Centre since fested by unrelievable pain, limitation of function, and 1966 in the knees of patients with rheumatoid arthri- deformity. In all cases there was greater articular surface tis, following the description of the use of these damage than could be expected to be improved by synovectomy. The radiographic appearances were prostheses for the relief of pain and the correction of otherwise not important unless there was gross joint deformity by MacIntosh (1966). Since that time collapse or destruction, since there was considerable thfre have been several reports of the use of these discrepancy between the radiographic appearances and prostheses in both rheumatoid and osteoarthrotic the findings at operation. knees (Potter, 1969; MCCollum, Goldner, and Lang, 1970; Clary and Couk, 1972; Jessop and Moore, Methods 1972; Kay and Martins, 1972; MacIntosh and METHOD OF REVIEW Hunter, 1972; Potter, Weinfeld, and Thomas, 1972). At final review the patients were interviewed and examined In view of the different indications for and the by an independent orthopaedic surgeon (B.B.), followingcopyright. results of the operation described by these various a standard protocol* which assessed the technical success authors, it seemed valuable to undertake an in- of the procedure and stressed functional improvements dependent review of the patients treated in this and difficulties.
    [Show full text]
  • Conformational Limb Abnormalities and Corrective Farriery for Foals
    Conformational Limb Abnormalities and Corrective Farriery for Foals For the past couple of years the general public has questioned the horse industry, and one of the questions is “Are we breeding horses more prone to breakdown with injuries”? It seems that we hear more often now that there are more leg and foot problems than ever before. Is it that we are more aware of conformational deficits and limb deviations, or are there some underlying factors that make our horses prone to injury? To improve, or even just maintain the breed, racing should prove soundness as well as speed and stamina. 1 The male side is usually removed from the bloodline if unable to produce good results at the racetrack. However, the female may have such poor conformation that she never even gets into training, but yet she enters the broodmare band. The generational effect of this must surely lead to an increase in the number of conformational deficits in our foals and yearlings.1 Something that we hear quite often is “Whoever saw the perfect horse”? and “There are plenty of horses with poor conformation that win races”. That doesn’t mean we should not continue to attempt to produce horses with good conformation. There is an acceptable range of deviation from the ideal, and therefore these deformities have to be accepted if it does not jeopardize the overall athletic soundness of the horse. Although mild conformational deficits may not significantly impact soundness, more significant limb deformities cause abnormal limb loading, lameness, gait abnormalities, and interference issues. 2 Developmental deformities of the limb include angular, flexural, and rotational limb deformities.
    [Show full text]
  • Realignment Surgery As Alternative Treatment of Varus and Valgus Ankle Osteoarthritis
    CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 462, pp. 156–168 © 2007 Lippincott Williams & Wilkins Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis Geert I. Pagenstert, MD*; Beat Hintermann, MD*; Alexej Barg, MD*; André Leumann, MD†; and Victor Valderrabano, MD, PhD† In patients with asymmetric (varus or valgus) ankle osteo- Level of Evidence: Level IV, therapeutic study. See the arthritis, realignment surgery is an alternative treatment to Guidelines for Authors for a complete description of levels of fusion or total ankle replacement in selected cases. To deter- evidence. mine whether realignment surgery in asymmetric ankle os- teoarthritis relieved pain and improved function, we clini- cally and radiographically followed 35 consecutive patients Surgical treatment for patients with symptomatic ankle with posttraumatic ankle osteoarthritis treated with lower osteoarthritis (OA) is controversial, particularly in me- leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average chanically induced, malaligned ankle OA in which joint patient age was 43 years (range, 26–68 years). We used a cartilage is partially preserved. These patients typically are standardized clinical and radiographic protocol. Besides dis- in their economically important, active middle ages be- tal tibial osteotomies, additional bony and soft tissue proce- cause early trauma is the predominant (70–80%) etiology dures were performed in 32 patients (91%). At mean fol- of their ankle OA.49,58 Currently, treatment recommenda- lowup of 5 years (range, 3–10.5 years), pain decreased by an tions after failed nonoperative therapy are polarized be- average of 4 points on a visual analog scale; range of ankle tween fusion2,11,33 and total ankle replacement motion increased by an average of 5°.
    [Show full text]
  • Osteotomy Around the Knee: Evolution, Principles and Results
    Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-012-2206-0 KNEE Osteotomy around the knee: evolution, principles and results J. O. Smith • A. J. Wilson • N. P. Thomas Received: 8 June 2012 / Accepted: 3 September 2012 Ó Springer-Verlag 2012 Abstract to other complex joint surface and meniscal cartilage Purpose This article summarises the history and evolu- surgery. tion of osteotomy around the knee, examining the changes Level of evidence V. in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years Keywords Tibia Osteotomy Knee Evolution Á Á Á Á (1940–2000) and Modern Later Years (2000–Present). We History Results Principles Á Á aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific Introduction indications. Materials and methods A thorough literature review was The concept of osteotomy for the treatment of limb defor- performed to identify the important steps in the develop- mity has been in existence for more than 2,000 years, and ment of osteotomy around the knee. more recently pain has become an additional indication. Results The indications and surgical technique for knee The basic principle of osteotomy (osteo = bone, tomy = osteotomy have never been standardised, and historically, cut) is to induce a surgical transection of a bone to allow the results were unpredictable and at times poor. These realignment and a consequent transfer of weight bearing factors, combined with the success of knee arthroplasty from a damaged area to an undamaged area of joint surface.
    [Show full text]
  • Skeletal Malalignment and Anterior Knee Pain: Rationale, Diagnosis, and Management
    Ch11.qxd 10/07/05 7:20 PM Page 185 11 Skeletal Malalignment and Anterior Knee Pain: Rationale, Diagnosis, and Management Robert A. Teitge and Roger Torga-Spak Introduction Association of Skeletal Any variation from optimal skeletal alignment Malalignment and Patellofemoral may increase the vector forces acting on the patellofemoral joint causing either ligament fail- Joint Pathology ure with subsequent subluxation or cartilage Abnormal skeletal alignment of the lower failure as in chondromalacia or arthrosis or both extremity has been associated with various ligament and cartilage failure (Figure 11.1). patellofemoral syndromes and biomechanical Anterior knee pain may result from these abnor- abnormalities. Our understanding of these asso- mal forces or their consequences. ciations continues to develop as many refer- The mechanical disadvantage provided by a ences consider only one aspect of the analysis. skeleton with a geometrical or architectural flaw In the frontal plane, malalignment has been distributes abnormal stresses to both the liga- shown to influence the progression of patello- ments and the joints of the misaligned limb. femoral joint arthritis.4,12 Varus alignment Ligament overload and subsequently failure increases the likelihood of medial patello- (insufficiency) may occur with a single traumatic femoral osteoarthrosis progression while valgus episode as well as repetitive episodes of minor alignment increases the likelihood of lateral trauma or chronic overload. Skeletal malalign- patellofemoral osteoarthrosis progression. ment may cause chondromalacia patella and Fujikawa13 in a cadaveric study found a marked subsequently osteoarthritis by creating an alteration of patellar and femoral contact areas increased mechanical leverage on the with the introduction of increased varus align- patellofemoral joint that can exceed the load ment produced by a varus osteotomy.
    [Show full text]
  • Bilateral Hallux Varus Deformity Correction with a Suture Button Construct
    A Case Report & Literature Review Bilateral Hallux Varus Deformity Correction With a Suture Button Construct Andrew R. Hsu, MD, Christopher E. Gross, MD, and Johnny L. Lin, MD common surgery for hallux varus correction is transfer of the Abstract extensor hallucis longus partially or completely under the deep Hallux varus deformity typically results from transverse intermetatarsal ligament to the lateral aspect base soft-tissue overcorrection at the metatarsopha- of the proximal phalanx.10,11 However, complications include langeal joint during surgery for hallux valgus. weakened extension and the inability to fix an overcorrected There are several soft-tissue procedures avail- intermetatarsal angle. Alternatively, the abductor hallucis can able for flexible hallux varus deformity includ- be tenotomized or transferred to the base of the proximal ing transfer of the extensor hallucis longus or phalanx to reconstruct the lateral capsular ligaments.8,9 The abductor hallucis. To our knowledge, there have lateral capsular ligaments can be reinforced or reconstructed not been any previous reports in the literature of with fascia lata or soft-tissue anchors, but these procedures rely bilateral hallux varus deformities in the setting of on adequate healthy tissue remaining around the MTP joint.9,12 potential pregnancy-related ligamentous laxity The Mini TightRope (Arthrex Inc, Naples, Florida) is an im- combined with iatrogenic injury. We present the planted suture endobutton device that has previously been used 13 case of an isolated bilateral hallux varus defor- for hallux valgus repair. The suture button technique has also mity occurring after pregnancy and prior bunion been used to recreate ligaments and tendons in syndesmotic 14,15 14 surgery.
    [Show full text]
  • Correlation of Rearfoot Angle to Q-Angle in Patellofemoral Pain Syndrome: a Prospective Study
    International Journal of Research in Orthopaedics Dileep KS et al. Int J Res Orthop. 2017 Jul;3(4):688-691 http://www.ijoro.org DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172089 Original Research Article Correlation of rearfoot angle to Q-angle in patellofemoral pain syndrome: a prospective study K. S. Dileep1*, Krishna Harish2, Rameez P. Mohammed3 1Department of Orthopaedics, K.S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India 2Musculoskeletal Disorders and Sports Physiotherapist Principal, Malabar Medical College, Allied Sciences, Kerala, India 3Physiotherapist, Jayashree Hospital, Mangalore, Karnataka, India Received: 22 April 2017 Revised: 05 May 2017 Accepted: 08 May 2017 *Correspondence: Dr. K. S. Dileep, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Objective of the study was to evaluate the correlation between rearfoot posture to Q-angle in patients with patellofemoral pain syndrome. Methods: This is a two-year prospective observational study in which all patients with patellofemoral pain syndrome in the age group of 20-30 years were included in the study. The static Q-angle and the rearfoot angles of these subjects were measured and analyzed statistically for their correlation. Results: There were sixty patients who fulfilled the inclusion criteria of the study. Pearson product moment correlation showed 27% subjects having rearfoot valgus and 73% having rearfoot varus angle.
    [Show full text]
  • Original Article: Correlation Between Subtalar Varus Angle
    Online Journal of Health and Allied Sciences Peer Reviewed, Open Access, Free Online Journal This work is licensed under a Published Quarterly : Mangalore, South India : ISSN 0972-5997 Creative Commons Attribution- Volume 8, Issue 3; Jul-Sep 2009 No Derivative Works 2.5 India License Original Article: Correlation between subtalar varus angle and disability in patients with patellofemoral arthritis Patel Birenkumar Jagdishbhai, Student, Gauri Shankar, Asst. Professor KJ Pandya College of Physiotherapy, Sumandeep Vidyapeeth University, Pipariya, Waghodia Road, Vadodara- 391760, Gujarat, INDIA Address For Correspondence: Gauri Shankar, KJ Pandya College of Physiotherapy, Sumandeep Vidyapeeth University, Pipariya, Waghodia Road, Vadodara - 391760 Gujarat, INDIA E-mail: [email protected] Citation: Patel BJ, Shankar G. Correlation between subtalar varus angle & disability in patients with patellofemoral arthritis. Online J Health Allied Scs. 2009;8(3):10 URL: http://www.ojhas.org/issue31/2009-3-10.htm Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html Submitted: Apr 24, 2009; Accepted: Nov 2, 2009; Published: Nov 15, 2009 Abstract: This study aimed at establishing a relationship if any between Aim: To find the correlation between subtalar varus angle & subtalar varus angle and disability in patient with patel- disability in patients with patellofemoral arthritis. Methods: A lofemoral pain. total of 30 subjects aged (48.86±5.74) referred to the depart- Materials and Methods: ment of physiotherapy, with patellofemoral arthritis and ful- A total of 30 subjects aged (48.86±5.74) referred to the depart- filling the criteria of inclusion were recruited for the study, ment of physiotherapy, Dhiraj General Hospital, Baroda, Gu- sampling method being convenient sampling.
    [Show full text]
  • Original Article
    DOI: 10.18410/jebmh/2015/878 ORIGINAL ARTICLE CORRECTIVE SURGERY IN CONGENITAL TALIPES EQUINOVARUS DEFORMITY: A CAMP APPROACH Antony R. Benn1, Rahul Verma2, Akshataa Atul Deshkar3, Vijaybabu Verma4, K. S. Bajpai5, Atul Manhorrao Deshkar6 HOW TO CITE THIS ARTICLE: Antony R. Benn, Rahul Verma, Akshataa Atul Deshkar, Vijaybabu Verma, K. S. Bajpai, Atul Manhorrao Deshkar. “Corrective Surgery in Congenital Talipes Equinovarus Deformity: A Camp Approach”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 39, September 28, 2015; Page: 6412-6417, DOI: 10.18410/jebmh/2015/878 ABSTRACT: The study was intended to assess the results of soft tissue release and bony corrective surgery in patients of moderate to severe deformed rigid club foot (CTEV) and neglected clubfoot (CTEV) at free disabled surgical camps at Chhattisgarh state. MATERIAL AND METHODS: In our study 50 patients were included with 70% male and 30% female with 4- 16 years of age group and 70% unilateral and 30% bilateral foot involvement. Patients were admitted and operated in different free disabled surgical camps at Chhattisgarh state over the period of 36 months (1 may 2004 to 30th April 2007). Improvement in functional ability and locomotion of all operated patients were assessed by physical and clinical examination. RESULTS: All patients who were operated in our study showed significant improvement in functional ability and locomotion after surgery. All patients were maintaining functional ability at follow up duration of 12 months (1 year). 75% patients were walking normally, 10% cases were walking with internal rotation of leg and 5% cases were walking with midtarsal varus foot with AFO with medial bar support.
    [Show full text]
  • Children with Lower Limb Length Inequality
    Children with lower limb length inequality The measurement of inequality. the timing of physiodesis and gait analysis H.I.H. Lampe ISBN 90-9010926-9 Although every effort has been made to accurately acknowledge sources of the photographs, in case of errors or omissions copyright holders arc invited to contact the author. Omslagontwcrp: Harald IH Lampe Druk: Haveka B.V., Alblasserdarn <!) All rights reserved. The publication of Ihis thesis was supported by: Stichling Onderwijs en Ondcrzoek OpJciding Orthopaedic Rotterdam, Stichting Anna-Fonds. Oudshoom B.V., West Meditec B.V., Ortamed B.Y .• Howmedica Nederland. Children with lower limb length inequality The measurement of inequality, the timing of physiodesis and gait analysis Kinderen met een beenlengteverschil Het meten van verschillen, het tijdstip van physiodese en gangbeeldanalyse. Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de Rector Magnificus Prof. dr P.W.C. Akkermans M.A. en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op woen,dag 17 december 1997 om 11.45 uur door Harald Ignatius Hubertus Lampe geboren te Rotterdam. Promotieconmussie: Promotores: Prof. dr B. van Linge Prof. dr ir C.J. Snijders Overige leden: Prof. dr M. Meradji Prof. dr H.J. Starn Prof. dr J.A.N. Verbaar Dr. B.A. Swierstra, tevens co-promotor voor mijn ouders en Jori.nne Contents Chapter 1. Limb length inequality, the problems facing patient and doctor. 9 Review of Ii/era/ure alld aims of /he studies 1.0 Introduction 11 1.1 Etiology, developmental patterns and prediction of LLI 1.1.1 Etiology and developmental pattern 13 I.
    [Show full text]