DOCSLIB.ORG

Spring Ligament Repair During Flatfoot Reconstruction APMA 2017

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Spring Ligament Repair During Flatfoot Reconstruction APMA 2017 Spring Ligament Repair During Flatfoot Reconstruction: Why it Should be Addressed When Correcting Sagittal Plane Deformities Nicholas A. Campitelli, DPM, FACFAS APMA National 7/28/2017 Nicholas A. Campiteli, DPM, FACFAS • Practice in multi-specialty group -Akron, OH • Board Certified in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery • Consultant for Medline Foot & Ankle Surgery Flat Foot Deformity • Frontal Plane • Transverse Plane • Sagittal Plane PTTD • Posterior Tibial Tendon • Is it “dysfunctional” Pathology • Spring Ligament • Attenuation leads to increased force on the posterior tibial tendon. Hentges MJ, Moore KR, Catanzariti AR, Derner R. Procedure selection for the flexible adult acquired flatfoot deformity. Clin Podiatr Med Surg. 2014 Jul;31(3):363-79. DiDomenico LA, Thomas ZM, Fahim R. Addressing stage II posterior tibial tendon dysfunction: biomechanically repairing the osseous structures without the need of performing the flexor digitorum longus transfer. Clin Podiatr Med Surg. 2014 Jul;31(3):391-404. Spring Ligament • Static Support of Medial Longitudinal Arch • Two Distinct Fibers Talus Navicular superomedial fibers Calcaneous inferior fibers Navicular Calcaneous Talus http://radsource.us/spring-ligament-tear/ Pathology • spring ligament abnormality = flatfoot deformity • Equal importance posterior tibial tendon dysfunction Williams BR, Ellis SJ, Deyer TW, Pavlov H, Deland JT. Reconstruction of the spring ligament using a peroneus longus autograft tendon transfer. Foot Ankle Int. 2010 Jul;31(7):567-77. Pathology • Spring Ligament and PT Tendon play essential role in elastic support of joint complex • Progressive strain on the mid- plantar sling is the most common cause of flatfoot, causing midfoot abduction Toullec E. Adult flatfoot. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S11-7. doi: 10.1016 Pathology • Regardless of the etiology, literature is demonstrating the spring ligament is failing and becoming attenuated, needs fixed • The most important static structure to be repaired for AAFD is the spring ligament. Wei S, Cai X, Yun G. [Progress in soft tissue reconstruction of adult-acquired flatfoot deformity]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Oct;26(10):1259-62. Posterior Tibial Tendon • May Still be functioning Spring Ligament • Soft tissue structure most open to fail • TN Joint Deformity Lee WC, Yi Y. Spring ligament reconstruction using the autogenous flexor hallucis longus tendon. Orthopedics. 2014 Jul;37(7):467-71. Isolated Spring Ligament Rupture • Acquired pes planus is due to a failure of the osseoligamentous complex • Could still perform a single heel rise Borton DC, Saxby TS. Tear of the plantar calcaneonavicular (spring) ligament causing flatfoot. A case report. J Bone Joint Surg Br. 1997 Jul;79(4):641-3. Procedure Selection • Lateral Column Lengthening • MDCO with FLD Transfer • Spring Ligament Repair Zanolli DH, Glisson RR, Nunley JA 2nd, Easley ME. Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model. J Bone Joint Surg Am. 2014 Mar 19;96(6):e45. MDCO • Reduces the load • adding FDL transfer small effect Arangio GA, Salathe EP. A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot. Clin Biomech (Bristol, Avon). 2009 May;24(4):385-90. Arthrodesis Spring Ligament Repair Spring Ligament Repair Spring Ligament Repair Spring Ligament Repair Summary • Repair needs focused on the stage and type of deformity. • Talonavicular Joint needs addressed • Flexible Need to repair Spring Ligament Complex Thank You.
Load more

Recommended publications
  • Total HIP Replacement Exercise Program 1. Ankle Pumps 2. Quad
    3 sets of 10 reps (30 ea) 2 times a day Total HIP Replacement Exercise Program 5. Heel slides 1. Ankle Pumps Bend knee and pull heel toward buttocks. DO NOT GO Gently point toes up towards your nose and down PAST 90* HIP FLEXION towards the surface. Do both ankles at the same time or alternating feet. Perform slowly. 2. Quad Sets Slowly tighten thigh muscles of legs, pushing knees down into the surface. Hold for 10 count. 6. Short Arc Quads Place a large can or rolled towel (about 8”diameter) under the leg. Straighten knee and leg. Hold straight for 5 count. 3. Gluteal Sets Squeeze the buttocks together as tightly as possible. Hold for a 10 count. 7. Knee extension - Long Arc Quads Slowly straighten operated leg and try to hold it for 5 sec. Bend knee, taking foot under the chair. 4. Abduction and Adduction Slide leg out to the side. Keep kneecap pointing toward ceiling. Gently bring leg back to pillow. May do both legs at the same time. Copywriter VHI Corp 3 sets of 10 reps (30 ea) 2 times a day Total HIP Replacement Exercise Program 8. Standing Stair/Step Training: Heel/Toe Raises: 1. The “good” (non-operated) leg goes Holding on to an immovable surface. UP first. Rise up on toes slowly 2. The “bad” (operated) leg goes for a 5 count. Come back to foot flat and lift DOWN first. toes from floor. 3. The cane stays on the level of the operated leg. Resting positions: To Stretch your hip to neutral position: 1.
    [Show full text]
  • Human Functional Anatomy 213 the Ankle and Foot In
    2 HUMAN FUNCTIONAL ANATOMY 213 JOINTS OF THE FOOT THE ANKLE AND FOOT IN LOCOMOTION THE HINDFOOT -(JOINTS OF THE TALUS) THIS WEEKS LAB: Forearm and hand TROCHLEAR The ankle, and distal tibiofibular joints READINGS BODY The leg and sole of foot Subtalar joint (Posterior talocalcaneal) 1. Stern – Core concepts – sections 99, 100 and 101 (plus appendices) HEAD 2. Faiz and Moffat – Anatomy at a Glance – Sections 50 and 51 Talocalcaneonavicular 3. Grants Method:- The bones and sole of foot & Joints of the lower limb & Transverse tarsal joints or any other regional textbook - similar sections IN THIS LECTURE I WILL COVER: Joints related to the talus Ankle Subtalar Talocalcaneonavicular THE MID FOOT Transverse tarsal Other tarsal joints THE FOREFOOT Toe joints METATARSAL AND PHALANGEAL Ligaments of the foot JOINTS (same as in the hand) Arches of the foot Except 1st metatarsal and Hallux Movements of the foot & Compartments of the leg No saddle joint at base is 1st metatarsal The ankle in Locomotion Metatarsal head is bound by deep Ankle limps transverse metatarsal ligament 1. Flexor limp Toes are like fingers 2. Extensor limp Same joints, Lumbricals, Interossei, Extensor expansion Axis of foot (for abduction-adduction) is the 2nd toe. 3 4 JOINTS OF THE FOOT JOINTS OF THE FOOT (2 joints that allow inversion and eversion) DISTAL TIBIOFIBULAR SUBTALAR (Posterior talocalcaneal) JOINT Syndesmosis (fibrous joint like interosseous membrane) Two (or three) talocalcaneal joints Posterior is subtalar Fibres arranged to allow a little movement Anterior (and middle) is part of the talocalcaneonavicular. With a strong interosseus ligament running between them (tarsal sinus) THE TALOCALCANEONAVICULAR JOINT The head of the talus fits into a socket formed from the: The anterior talocalcaneal facets.
    [Show full text]
  • Sports Ankle Injuries Assessment and Management
    FOCUS Sports injuries Sports ankle injuries Drew Slimmon Peter Brukner Assessment and management Background Case study Lucia is a female, 16 years of age, who plays netball with the Sports ankle injuries present commonly in the general state under 17s netball team. She presents with an ankle injury practice setting. The majority of these injuries are inversion sustained at training the previous night. She is on crutches and plantar flexion injuries that result in damage to the and is nonweight bearing. Examination raises the possibility of lateral ligament complex. a fracture, but X-ray is negative. You diagnose a severe lateral Objective ligament sprain and manage Lucia with ice, a compression The aim of this article is to review the assessment and bandage and a backslab initially. She then progresses through management of sports ankle injuries in the general practice a 6 week rehabilitation program and you recommend she wear setting. an ankle brace for at least 6 months. Discussion Assessment of an ankle injury begins with a detailed history to determine the severity, mechanism and velocity of the injury, what happened immediately after and whether there is a past history of inadequately rehabilitated ankle injury. Examination involves assessment of weight bearing, inspection, palpation, movement, and application of special examination tests. Plain X-rays may be helpful to exclude a fracture. If the diagnosis is uncertain, consider second The majority of ankle injuries are inversion and plantar line investigations including bone scan, computerised flexion injuries that result in damage to the lateral tomography or magnetic resonance imaging, and referral to a ligament complex (Figure 1).
    [Show full text]
  • Mcilroy's Ankle Injury Explained
    McIlroy’s Ankle Injury Explained By Eva Nugent MISCP The Anterior Talofibular Ligament is big news this week because of world number 1 golf player Rory McIlroy’s injury sustained while having a football “kick about” with friends. McIlroy reports sustaining a “total rupture of his left ATFL and damage to the associated ankle joint capsule”. This unfortunate injury has put his golf season in doubt with the Open Championship starting just next week the 16th of July. But what exactly is the ATFL? And what does the rehabilitation for this injury involve? The Anterior Talofibular Ligament is one of three ligaments that make of the lateral ligament complex of the ankle joint. It originates at the fibular malleoulus of the lateral shin bone (fibula) and runs forward to and attaches to the Talus (ankle bone). The other two ligaments are the Posterior talofibular ligament (PTFL) and the Calcaneofibular ligament (CFL). The function of these ligaments is to provide stability and support to the ankle joint. The ATFL specifically prevents the anterior translation of the shin in relation to the foot/ankle. The ATFL is the most commonly injured ankle ligament and is most vulnerable when the foot is pointing downwards and inwards as the body’s centre of gravity rolls over the ankle (plantarflexed and inverted position). This is commonly described as “going over on your ankle”. It is commonly injured in sports like football or GAA where unpredictable fast turns or cutting movements are involved. This is referred to as an ankle sprain and results in damage to the fibres of the ligament as they are overstretched.
    [Show full text]
  • How to Self-Bandage Your Leg(S) and Feet to Reduce Lymphedema (Swelling)
    Form: D-8519 How to Self-Bandage Your Leg(s) and Feet to Reduce Lymphedema (Swelling) For patients with lower body lymphedema who have had treatment for cancer, including: • Removal of lymph nodes in the pelvis • Removal of lymph nodes in the groin, or • Radiation to the pelvis Read this resource to learn: • Who needs self-bandaging • Why self-bandaging is important • How to do self-bandaging Disclaimer: This pamphlet is for patients with lymphedema. It is a guide to help patients manage leg swelling with bandages. It is only to be used after the patient has been taught bandaging by a clinician at the Cancer Rehabilitation and Survivorship (CRS) Clinic at Princess Margaret Cancer Centre. Do not self-bandage if you have an infection in your abdomen, leg(s) or feet. Signs of an infection may include: • Swelling in these areas and redness of the skin (this redness can quickly spread) • Pain in your leg(s) or feet • Tenderness and/or warmth in your leg(s) or feet • Fever, chills or feeling unwell If you have an infection or think you have an infection, go to: • Your Family Doctor • Walk-in Clinic • Urgent Care Clinic If no Walk-in clinic is open, go to the closest hospital Emergency Department. 2 What is the lymphatic system? Your lymphatic system removes extra fluid and waste from your body. It plays an important role in how your immune system works. Your lymphatic system is made up of lymph nodes that are linked by lymph vessels. Your lymph nodes are bean-shaped organs that are found all over your body.
    [Show full text]
  • Active Ankle & Foot Range of Motion Exercises
    1501 North Bickett Blvd. Suite E ~ Louisburg, NC 27549 ~ Phone (919) 497-0445 ~ Fax (919) 497-0118 ACTIVE ANKLE & FOOT RANGE OF MOTION EXERCISES Do each exercise _____ times a day. Repeat each exercise ______ times. ANKLE ALPHABET o Moving only your ankle and foot, “write” each letter of the alphabet from A to Z. o Keep your leg straight. o Do not bend your knee or hip. o The letters will start out small and get larger as your ankle motion improves. ANKLE PUMPS o Move your foot up and down as if pushing down or letting up on a gas pedal in a car. ANKLE INVERSION / EVERSION o Move your foot side to side as if mimicking a windshield wiper. o Be sure not to move knee while performing exercise *If you have any questions about these guidelines – or the appropriateness of any other activities – please call Orthopaedic Specialists of North Carolina at (919) 497-0445. 1501 North Bickett Blvd. Suite E ~ Louisburg, NC 27549 ~ Phone (919) 497-0445 ~ Fax (919) 497-0118 ANKLE CIRCLES o Make circles with your foot. o Go clockwise then repeat counter clockwise. TOE CURLS o Moving only your toes, curl and uncurl each digit as far as possible within your pain free range. o Option: Pick-up marbles with toes 1 at a time for 5 minutes. TOE CURLS WITH TOWEL o Bunch up a towel curling your toes TOWEL SLIDES o Moving only your ankle and keeping your heel planted, slide the towel to the inside, then outside. *If you have any questions about these guidelines – or the appropriateness of any other activities – please call Orthopaedic Specialists of North Carolina at (919) 497-0445.
    [Show full text]
  • PATIENT INFORMATION Ankle Arthritis
    PATIENT INFORMATION Ankle Arthritis The ankle joint The ankle is a very complex joint. It is actually made up of two joints: the true ankle joint and the subtalar ankle joint. The ankle joint consists of three bones held together by cartilage and ligaments. The tibia forms the inside of the true ankle joint. The fibula forms the outside of the true ankle joint. The talus is the underneath part of the true ankle joint. The true ankle joint allows you to move your foot up and down. The subtalar joint consists of two bones, the talus on top and calcaneus on the bottom. The subtalar joint allows you to move your foot from side to side. What is ankle arthritis? Most ankle arthritis is caused by wear and tear which reduces the shiny cartilage that lines the joint causing bone to rub on bone which is painful. (However, there are other forms of arthritis that affect the ankle, for example, rheumatoid arthritis.) Early symptoms of ankle arthritis are pain and perhaps swelling and stiffness, especially after prolonged activity including standing or walking, or after high impact activities, for example running. If you have ankle arthritis, pain, swelling and stiffness can become more frequent as the disease progresses. Eventually you will probably feel pain most of the time, even when you are not active. Healthy ankle joint Arthritic ankle joint Source: Trauma & Orthopaedics Reference No: 5417-3 Issue date: 01/03/2021 Review date: 01/03/2024 Page: 1 of 6 Osteoarthritis is often secondary to damage to the joint, for example as a result of a previous fracture, repeated sprains of the ankle, malalignment of the joint or infection.
    [Show full text]
  • Ankle Joint Type: Uniaxial Hinge Joint
    Ankle Joint Type: Uniaxial hinge joint. (Dorsiflexion – 100 with straight knee, 30 with flexed knee; Plantar flexion 30. Articulating Surfaces: Lower end of tibia & medial malleolus. -Lateral Malleolus & inferior transverse tibiofibular ligament. -Body of talus, medial & lateral surfaces of talus. -Covered by hyaline cartilage. Close Pack position: Dossiflexion – all thursting movements e.g. walking, running, jumping start with this. Synovial membrane: Lined by synovial membrane which projects into distil tibiofibular joint. Fibrous capsule: Thin infront and behind. Proximally attached to borders of tibial and malleolar articular surfaces. Distally to talus in front reaches the dorsum of neck. Posteriorly mainly transverse fibres and blends with inferior transverse ligaments. Ligaments: Medial ligament: Strong triangular band. Very stable. Apex: Attached above to medial malleolus Base: To across a line that extends from navicular tuberosity to medial tubercle of talus. Superficial part: 1. Tibionavicular- from medial malleolus to navicular tuberosity and to plantar calcaneo navicular ligament. 2. Tibiocalcaneal: central, from medial malleolus to sustentaculum tali of calcaneum. 3. Posterior Tibiotalar: To medial side & medial tubercle of talus. Deep part: Anterior tibiotalar which pass from medial Lateral ligament: Composed of three separate ligaments. Anterior talofibular: from anterior margin of lateral malleolus to adjacent lateral aspect of body and neck of talus. Posterior talofibular: horizontally, backwards and medially from lateral margin to posterior process of talus. Calcaneofibular: From malleolar fossa of lateral malleolus posteroinferior to tubercle of lateral calcaneal surface. Commonly injured in inversion sprains (during sports). Relations: Anteriorly – medial to lateral – tibialis anterior, extensor haullicis longus, anterior tibial artery, deep peroneal nerve, extensor digitorum longus and peroneus tertius.
    [Show full text]
  • Hip, Knee Joints and Ankle Joints
    Hip, knee joints and ankle joints Musculoskeletal block- Anatomy-lecture 18 Editing file Color guide : Only in boys’ slides in Green Only in girls’ slides in Purple Objectives Important in Red Doctor’s notes in Blue Extra information in Grey ✓ List the type & articular surfaces of hip joint , knee joint and ankle joint. ✓ Describe the ligaments of hip joints and ankle joint. ✓ Describe movements of hip joint, knee joint and ankle joint. ✓ Describe the capsule of knee joint, its extra- & intra-capsular ligaments. ✓ List important bursae in relation to knee joint. ✓ Apply Hilton’s law about nerve supply of knee joints. ● Type: a synovial, ball & socket joint The Hip Joint ● Articular surfaces: -acetabulum of hip (pelvic bone) Ligaments: -head of the femur Intracapsular Extracapsular Transverse Ligament Iliofemoral Pubofemoral Ischiofemoral Acetabular labrum acetabular of femoral ligament ligament ligament ligament head -Fibro-cartilaginous Converts Carries -Y shaped - Antero- inferior -Posterior to collar acetabular notch vessels to -Anterior to to joint joint -Attached to margins into foramen head of joint of acetabulum → (acetabular foramen) femur -Limits -Limits -Limits medial increases its depth through which the extension abduction and rotation for better retaining acetabular vessels lateral rotation of head of femur pass Pictures in the following slide Intracapsular Extracapsular Movements Hip Dislocations Congenital • More common in girls and Medial Lateral associated with inability to adduct Flexion Extension Abduction Adduction
    [Show full text]
  • High Ankle Sprains: Diagnosis & Treatment
    High Ankle Sprains: Diagnosis & Treatment Mark J. Mendeszoon, DPM, FACFAS, FACFAOM Precision Orthopaedic Specialties University Regional Hospitals Advanced Foot & Ankle Fellowship- Director It Is Only an Ankle Sprain Evaluate Degree of Ecchymosis & Edema If Not Properly Treated Chronic Pain & Ankle Instability Epidemiology Waterman et al. JBJS 2010 states: 2 million ankle sprains per year = 2 billion in health care cost Injury results in time lost and disability in 60% of patients 30% of all sport injury Epidemiology Syndesmotic Injuries: •1% to 18% of all ankle sprains • 32% develop calcification and chronic pain •High incidence of post traumatic arthritis Greater source of impairment than the typical lateral ankle sprain Anatomy Inferior Tibiofibular Joint: defined as a syndesmotic articulation which consists of five separate portions Motion in all three planes Anatomy “Syndesmotic Ligaments: • Anterior Inferior Tibio Fibular Ligament • Posterior Inferior Tibio Fibular Ligament • Transverse Tibio Fibular Ligament • Interosseous Ligament • Interosseous Membrane Deltoid Ligament The deep portion of the deltoid ligament also contributes to syndesmotic stability Acting as a restraint against lateral shift of the talus Biomechanics of Syndesmosis RELEVANT ASPECTS OFANKLE: A considerable clearance takes place between the talus and the distal fibula, which is limited by the tibiofibular syndesmosis With normal stance, almost no twisting and shearing forces act on the ankle joint= static tibfib tension Axial loading tensions AITF and PITF with increase of 10 -17% of body weight intact syndesmosis, the intermalleolar distance increases with dorsiflexion of the talus by 1.0 to 1.25 mm Haraguchi et al. 2009 Intact syndesmosis Fibula ROTATES 2 * externally Equals ~ 2.4 mm distally 0.2-0.4 mm Anterior -posteriorly THUS Fibula moves in 3 D Ogilvie & Harris 1994 Study on Individual Ligaments for Syndesmotic Stability 35% ATIFL 33% TRANSVERSE LIG.
    [Show full text]
  • Ankle Strengthening PROTOCOLS
    Ankle Strengthening PROTOCOLS BACKGROUND • Purpose ` o Improve muscular strength Regain balance and proprioception o o Increase functional abilities o Rehab exercises should be performed for 6- 8 weeks. • Related activities: o As symptoms improve, slowly return to physical activities such as bicycle, stair climber and elliptical o Skipping rope is a good activity to try prior to returning to jogging. STRETCHING EXERCISES: Calf Stretch Stretch 1: Stand with the ball of the foot against the wall Slowly move body towards the wall until stretch is felt Stretch 2: Stand facing a wall and step back with one leg. Push heel towards the ground. Frequency: 3 sets x 1 min. 2-3 times a day. Goal: Increase range of motion ANKLE STRENGTH EXERCISES: Ankle Dorsiflexion Begin by attaching the theraband to a stable object Sitting on the ground with the theraband around your foot Slowly pull your toes up towards you Frequency: 3 sets x 15 reps. 1-2 times a day. Goal: Increase ankle strength Ankle Eversion Sit in a chair with the theraband attached to a stable object Keeping the knee and thigh still, rotate foot out away from the body Frequency: 3 sets x 15 reps. 1-2 times a day. Goal: Increase ankle strength Ankle Inversion Sit in a chair with the theraband attached to a stable object Keeping the knee and thigh still, rotate foot in towards the body : 3 sets x 15 reps. 1-2 times a day. Frequency Goal: Increase ankle strength UCSF Orthopaedic Institute | 1500 Owens Street Ste 170 | San Francisco, CA 94158 | Phone: 415-353-2808 | Fax: 415-353-7593 | orthosurg.ucsf.edu Ankle Strengthening PROTOCOLS ANKLE STRENGTH Calf raises Stand with the balls of your feet on a step Slowly rise up onto your toes and hold for 3 sec.
    [Show full text]
  • Radiographic Positioning of the Foot & Ankle
    Radiographic Positioning of the Foot & Ankle Daniel P. Evans, D.P.M., FACFAOM, FFRCPS(Glasgow) Professor, Dept. of Podiatric Medicine and Radiology Positioning of the RADIATION SAFETY It is your responsibility to limit X-Ray exposure to both the patient as well as yourself. Use appropriate lead aprons, lead gloves. Appropriately collimate X-ray to limit exposure. Stand behind protective barrier when making exposure. Pre-Plan to eliminate the need to re-expose the patient! What is your office policy regarding questioning women of child bearing age as to whether or not they might be pregnant? Dorsal Plantar / DP Foot WB Dorsal plantar/ DP Projection Foot What are some indications for ordering this Projection? What are some keys to proper positioning for this Projection? Dorsal Plantar / DP Foot O degrees Marked Lesion Dorsal plantar/ DP Projection Marked Lesion What might be some indications for taking a marked lesion X-Ray? Foreign Body. Ulcer location to assess for infection. Nucleated hyperkeratotic lesion – Which metatarsal is causing the excessive pressure. Dorsal plantar/DP Projection Tube angle = 0o Tube angle = 15o Lateral Foot WB Lateral Projection Foot 1 2 Lateral Raised Hallux WB Lateral Raised Hallux Lateral Hallux Alternate Method Lateral Raised Digit WB Lateral 2nd Digit Lateral Oblique Projection/Medial Oblique View Foot WB Lateral Oblique Projection Third most common film view Completes “three views” that most physicians utilize Shows the lateral side of the foot well Good Visualization Lateral toes, Metatarsals,
    [Show full text]