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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.