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PES PLANUS

 

MUJAHIDA ISLAM

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  Although fexible pes planus rarely requiressurgical treatment, rigid pes planusrequently causes enough symptoms to

 justiy operation.   Congenital vertical talus is probably the

most severe example o rigid pes planus, itis most oten treated in inancy.

   Tarsal coalition, another common cause origid pes planus.

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  P! P"A#$!

  %"&'(" P! P"A#$!

  )'*'+ P! P"A#$!

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PES PLANUS

  Pes planus (fatoot) by convention reers to

loss o the normal medial longitudinal arch.

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  FLEXIBLE PES PLANUS

  ' an acceptable medial longitudinal arch

does appear ith non-eight bearing, pesplanus is termed fexible.

  RIGID PES PLANUS

  ' an acceptable medial longitudinal archdoes not appear ith non-eight bearing,pes planus is termed Fixed , or Rigid .

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. Congenital /ertical Talus.

2. Tarsal Coalition.

0. Accesory naviular bone.

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  Tarsal Coalition the 2brous, cartilaginous,or bony usion o to or more o the tarsalbones, oten resulting in TA"'P!

P"A#3/A"*$!

  A bloc4 beteen to bones, hich may beosseous cartilaginous or 2brous.

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   The cause o tarsal coalition is almostirreutably a ailure o primitivemesenchyme to segment by cleavage in

the 567 to 657mm etus and produce thenormal peritalar joint complex.

  A uniactorial disorder o Autosomal

Dominant Inheritance ith nearly ullpenetrance

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  Coronal sectionthrough oot o!2."#mm etus

sho$ing com%leteme&ialtalocalcaneal'ri&ge.

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  Calcaneona(icular .

  Talocalcaneal.

   Talonavicular

  Calcaneocuboid.

  #aviculocuboid.

  #aviculocuneiorm.

 

8assive tarsal coalition.

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  Calcaneonavicular coalition 9%ig. 6:70 (;as described by the anatomistsoll 9==?;, and P2t@ner

9=:; ater they perormed laboratorydissections.

  't as not until :5? that !lomann

suggested the association o pes planus,tarsal coalition, and rigidity o the hindoot.

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  Although probably present since birth, theC!cne"nvic#!r $r does not ossiy until = to5 years old.

  (eore this period, presumably because o themalleability o the cartilage surrounding theprimary ossi2cation centers o the peritalarcomplex, signi2cant symptoms are rare.

't is believed that as the cartilage ossi2es, hindoot

stiBness results, and the patients ability toithstand the stress o vigorous childhood activitydeclines.

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  Com%lete

  (ony9synostosis;

 

Incom%lete  Cartilaginous9synchondrosis;

  %ibrous9syndesmosis;

 

Incom%lete coalitions) that is)cartilaginous or *'rous) usuall+ are themore s+m%tomatic.

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S+m%toms

. /ague dorsolateral oot pain centeringaround the sinustarsi.

5. +iDculty al4ing on uneven suraces.0. %oot atigue.

E. 3ccasionally a painul limp.

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  Signs

. 8ay or may not sho signi2cant reductiono subtalar motion.

5. %lattening o the longitudinal arch.

  So a high in&e, o sus%icion isnecessar+ in this %atient %ro*le.

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   The abnormal bar runsrom the anterior processo the calcaneus justlateral to the anterioracet dorsally and

medially to the lateraland dorsolateralextraarticular surace othe navicular.

  't usually is to 5 cm

long F to .5 cm ide.

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. 'n a bar ith a cartilaginous or 2brous interace,the adjacent bony margins are irregular andindistinct.

5.  The talar head might appear small andunderdeveloped.

0. (ea4ing o the dorsal articular margin o thetalus, so common in talocalcaneal coalition, isuncommon in calcaneonavicular coalition

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  'n a revie o plainradiographs o tarsal

coalitions, also notedthat the bar andaltered navicularmorphology could beseen on Stan&ar&Antero%osteriorradiographs.

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  CT should not beneeded to diagnosethis type o coalition.

   To identiy coalitionearlier.

 

 To diagnose cases orecurrence.

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  Conservative

 

!urgical

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  A trial o reduced activity or castimmobili@ation or both is recommended.

  A patient may be rendered asymptomatic orvarying periods or even inde2nitely ater Eto ee4s in a cast. 'ntermittent casting orshort periods, ith lengthy intervals o

noncasting, might be all that is required.

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   The mere presence o a tarsal coalition doesnot mean surgery should be recommended.

   i patients ith tarsal coalition reach their5?s ith e or no symptoms, theyrequently remain asymptomatic or are onlymildly symptomatic.

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  Indicti"n

  ' a trial period o casting and the use o amolded, 2rm arch support do not allo an

adolescent to participate in activities he orshe enjoys, surgical treatment isrecommended.

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  The most commonl+ acce%te& surgicaltreatments are

. )esection o the Calcaneona(icular -ar

ith interposition o muscle or at.5. !ubtalar arthrodesis.

0. Triple arthrodesis.

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   The contribution o >arris and (eath in thedescription o talocalcaneal coalition in :E=cannot be overemphasi@ed. (eore this time,rigid pes planus, ith or ithout peroneal

spasm, had never been attributed totalocalcaneal coalition.

 

 They reported a Gt!"c!cne! $ridge% obone beteen the sustentaculum and talus in5 o 6 eet ith Grigid pes planus.H

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   Talocalcanealcoalition. A and (,%iteen7year7old boy

ith bilateral medialacet talocalcanealcoalition.

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   The t!"c!cne! $ridge ossi2es eithercompletely or incompletely beteen 5 and years old, hich is later than theossi2cation o the calcaneonavicular barand usually is diagnosed in olderadolescents or adults.

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  S+m%toms

   The symptoms are similar to those ocalcaneonavicular coalitionI

. %oot atigue5. Pain around the hindoot on increased

activity.

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  ' routine vies o theoot plus the coalitionvie do not con2rm asuspected medialtalocalcaneal coalition,CT scan may behelpul.

  !tandard or diagnosis

o talocalcanealcoalitions

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  MI may be helpul indepicting all types ocoalitions, including2brous coalitions.

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  Conservative

  !urgical

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. A trial o conservative treatment isrecommended, including reduced activity, Eto ee4s in a short leg al4ingcastolloed by a period o earing 2rmarch supports.

5. A Steroi& In/ection ithin the sinus tarsi.

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  Indicti"n

  %ailure o conservative treatment.

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  The most commonl+ acce%te& surgicaltreatments are

. )esection o a 8iddle %acet Tarsal Coalition

5. Triple arthrodesis.