Symptoms
Complain of pain with prolonged standing
Complain feet tire easily
Examination
Overall alignment
Heel raises
Flexibility of Flat foot / STJ
T Achilles tightness
X-ray
Meary's angle
- Talus - first MT angle
- lateral weight bearing view
Grading
- 0o normal
- mild - 15o
- severe - 30o
Non Operative
Medial arch support
Medial heel raise
UCBL
Operative
Indications
- failure non operative measures
- inability to wear shoes
Surgery
1. Evans anterior calcaneal osteotomy
Theory
- lateral column lengthening
Technique
- incision tip of fibula to base of 4th MT
- elevate EDB anteriorly
- peroneal tendons anteriorly
- sural nerve posteriorly
- identify CCJ joint but do not open capsule
- insert Homan retractor and identify interval between middle and anterior facet
- osteotomy between the two, 1.5 cm from CCJ
- insert lamina spreader, assess arch at this point
- insert tri-cortical iliac crest bone graft (slightly trapezoidal) with bone tamp
- 1cm opening wedge
- stabilise with plate or screws
2. Medial reefing / repair spring ligament / FDL Transfer
- incision at inferior aspect head of talus
- above tibialis posterior tendon
- excise segment of spring ligament approximately 6mm
- reapproximate ligament with non absorbable sutures
3. Medial Cuneiform Plantarflexing Osteotomy
Indication
- Restore weight bearing tripod
Technique
Dorsal osteotomy mid-substance cuneiform
- lever open with osteotome
- 4 - 7 mm tri-cortical graft
- fixation with 2 x screw
Post operative
- back slab
- wound check at 1 week
- sutures out at 2 weeks unless DM or RA
- SL POP for 6/52 NWB
- then WBAT in boot 6/52
4. +/- T Achilles lengthening
- if unable to passively DF ankle past 10o with knee extended
Post op
- POP for 6/52 (mould into arch)
- arch support / UCBL for 6/12