University of Debrecen
Departement of
Orthopaedic Surgery 1/66
The anatomy of the foot. Diseases of the
leg: flat foot, bunion, hammer toe.
Congenital deformities:
clubfoot, vertical talus.
26 bones
57 joints
2/66
Joints of the foot
Subtalar
Chopart
Lisfranc
I MTP
3/66
Functions of the foot
•Static functions: - Lateral column of the foot: calcaneus, cuboideum, IV, V metatarsus → weight bearing, support •Dinamic functions:
- Medial column of the foot: talus, naviculare, cuneiform I, II, III → walking, energy absorption
4/66
Body weight
5/66
Construction of the foot
DE OEC
Ortopédiai Klinika
Muscles responsible for holding
the longitudinal arch:
•posterior tibial muscle
•flexor digitorum longus muscle
•flexor hallucis longus muscle
•peroneal muscle
Muscles responsible for holding
the transversal arch :
•adductor hallucis muscle
•long peroneal muscle
•anterior tibial muscle
6/66
Normal versions of the forefoot
Greek Egypt Square
7/66
DE OEC
Ortopédiai Klinika
Functional anatomy
8/66
9/66
• Pes equinus (talpies equinus): plantarflexion in the talocrural joint
• Pes calcaneus: the foot is in dorsal extension
• Pes cavus (excavated foot): forefoot is in flexion compared to the hindfoot, high longitudinal arch
Deformities in the saggital plane
10/66
• Pes varus: the calcaneus turns inward at the subtalar joint
• Pes valgus: the calcaneus turns outward at the subtalar joint
• Pes adductus (metatarsus varus, intoe): the forefoot turns medially in the Chopart-joint
• Pes supinatus (inverted foot): the forefoot is in supination in the Chopart-joint
• Pes abductus: the forefoot turns laterally in the Chopart-joint
Deformities in the frontal plane
11/66
DE OEC
Ortopédiai Klinika
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
12/66
DE OEC
Ortopédiai Klinika
Deformities in clubfoot
13/66
-pes
-equino
-varus
-adductus et
-plantiflexus
-congenitus
DE OEC
Ortopédiai Klinika
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
14/66
• Boys: girls = 2:1
• Often 2 sided
• Prevalence in Europe 1-2 ‰
• Etiology: multifactorial = genetic +
environmental factors
• Familial aggregation
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
15/66
16/66
17/66
DE OEC
Ortopédiai Klinika
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
18/66
DE OEC
Ortopédiai Klinika
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
19/66
DE OEC
Ortopédiai Klinika
Cheselden 1768.
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
20/66
DE OEC
Ortopédiai Klinika
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
21/66
DE OEC
Ortopédiai Klinika
Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
22/66
IOWA (Ponseti) Clubfoot
Protocol Igancio Ponseti
Casting technique
Forefoot supination
Holding the head of
the talus laterally
No pronation
No dorsalextension
23/66
IOWA (Ponseti) Clubfoot
Protocol Igancio Ponseti
Total, horizontal
percutaneous
Achillotomy to correct
the equinus at the 6-
7th week of casting.
Further casting:
15º dorsal extension
70 º abduction
24/66
IOWA (Ponseti) Clubfoot
Protocol Igancio Ponseti
Postoperative care
Ponseti brace until
the age of 3-4
years.
25/66
DE OEC
Ortopédiai Klinika
Surgical treatment
(Cincinnati incision)
26/66
DE OEC
Ortopédiai Klinika
Surgical treatment
(Cincinnati incision)
27/66
DE OEC
Ortopédiai Klinika
Surgical treatment
28/66
DE OEC
Ortopédiai Klinika
Surgical treatment
(Cincinnati incision)
29/66
DE OEC
Ortopédiai Klinika
Pes adductus
30/66
DE OEC
Ortopédiai Klinika
Pes adductus
31/66
DE OEC
Ortopédiai Klinika
Surgical treatment
32/66
DE OEC
Ortopédiai Klinika
Pes excavatus
33/66
Vertical talus
(Pes calcaneovalgus congenitus)
34/66
DE OEC
Ortopédiai Klinika
Synostosis calcaneo-navicularis,
tarsal coalition
35/66
DE OEC
Ortopédiai Klinika
Developmental diseases
36/66
37/66
38/66
39/66
DE OEC
Ortopédiai Klinika
Fejlődési rendellenességek
40/66
41/66
42/66
43/66
DE OEC
Ortopédiai Klinika
Fejlődési rendellenességek
44/66
DE OEC
Ortopédiai Klinika
Aseptic necrosis of the navicular bone
Köhler I.
45/66
DE OEC
Ortopédiai Klinika
Aseptic necrosis of the head of the II.
metatarsus; Köhler II.
46/66
DE OEC
Ortopédiai Klinika
Calcaneal apophysitis; Morbus Schintz
47/66
Static foot deformities
• Flattened longitudinal arch (flat foot)
• Flattened transversal arch
• Hallux valgus/Bunion
• Other toe-deformities
48/66
DE OEC
Ortopédiai Klinika
Pes planus/
Pes planovalgus/ Calcaneovalgus/
Fallen arch/ Flat foot)
49/66
DE OEC
Ortopédiai Klinika
Pes planus (flat foot)
50/66
DE OEC
Ortopédiai Klinika
Pes planus (flat foot)
•The arches develop until the age of 2-3
•Symptomless in childhood
•The inner side of the shoe is worn off
•Risk: pregnancy, obesity
51/66
52/66
DE OEC
Ortopédiai Klinika
Treatment of pes planus (flat foot)
Prevention:
•Walking on uneven surface;
•Pick up the child, when tired;
•Foot-gymnastic
In childhood:
•gymnastic
•shoe sole – supinating wedge
•surgery
Adulthood, in case of complain:
•shoe sole
•surgery
53/66
Pedes transversoplani
(flattened transversal arch)
• Leads to:
– metatarsalgia
– toe deformities (hammer toe, hallux valgus)
• Treatment: gymnastic, shoe sole, surgery
54/66
• Weil OT
Pedes transversoplani
(flattened transversal arch)
55/66
DE OEC
Ortopédiai Klinika
Hallux valgus (Bunion)
56/66
Hallux valgus
• 1. Lateral deviation of
the hallux
• 2. Medial deviation of
the I. MT
• 3. Pronation of the
hallux
57/66
Treatment:
• Hallux valgus correction orthesis
• Shoe sole
• Orthopedic shoes
• Surgeries: soft tissue - surgery, removing
exostosis, osteotomies, arthrodesis,
resection arthroplasties
Hallux valgus (Bunion)
58/66
DE OEC
Ortopédiai Klinika
Surgical solutions
59/66
DE OEC
Ortopédiai Klinika
Surgical solutions
60/66
DE OEC
Ortopédiai Klinika
Surgical solutions
61/66
DE OEC
Ortopédiai Klinika
Hammer toe
62/66
DE OEC
Ortopédiai Klinika
Calcar calcanei
63/66
Haglund heel
64/66
65/66
66/66
Top Related