Foot
Kohler's Disease
Definition
Osteonecrosis of the navicular
Epidemiology
Present at age 4-6 years
- same as Perthes disease
M:F 5:1
Bilateral in 20%
Aetiology
Repetitive trauma to maturing ossific nucleus
Anatomical Approach to Biopsy
Region specific approaches
Theory
- want to traverse one muscle / one compartment
- keep away from NV bundle
- as a rule perform open biopsy through compartment the tumour is in
- this is the compartment that will require surgical removal in wide excision
- direct approach without going through muscle if possible i.e. tibia, distal ulna
Lower Limb
Thigh
Knee & Foot
Principles
Foot
A little equinus is better than calcaneus
A little valgus is better than varus
A little varus is better than severe valgus
TA lengthening is most over used operation in CP
Knee
A little knee flexion is better than recurvatum
Knees
Problems
Tight hamstrings
Foot & Ankle Exam
Look
Aids
Shoes - raises / wear patterns
Stigmata generalised disease
Hands - RA, CMT
Front
Knee alignment
Forefoot - Hallux & Lesser toes
Scars
Circulatory changes
Medial Side
Turn affected side away & ask to step foot forward
Flexed attitude of knee
Medial arch - planus / cavus
Total Contact Cast
Mechanism
TCC’s heal ulcers by reducing pressure
- 1/3 of load is taken by wall of cast & transmitted to the leg
- 45% reduction in forefoot pressure but not heel pressure
Charcot Joint
Definition
Neuropathic Arthropathy
Progressive destructive arthropathy 2° to neurological condition
- usually minimal to no trauma
Aetiology