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07/10/2013 Robert D. Phillips, DPM
Surgical Intervention in a 12 Year Old with Flat Foot
This is a good example of why a biomechanical examination is so important in trying to make surgical decisions.
Some of the important information needed includes: 1. The angular range of motion of the subtalar joint on the frontal plane.
2. The heel to leg angular relationship when the subtalar joint is in neutral position.
3. The linear relationship, how many mm medial or lateral the center of the bottom of the heel is to the to the center of the leg when the STJ is neutral and also maximally pronated.
4. The ratio of transverse plane motion to frontal plane plane motion in the STJ.
5. The presence of any genu varum or tibial varum or valgum.
6. The plot of the STJ axis to the bottom of the foot when the STJ is in neutral and also when the STJ is pronated enough to bring the FF flat on the ground.
7. The forefoot to rearfoot relationship with the MTJ is fully pronated, and when subtalar joint is in neutral, and again when the STJ is fully pronated.
8. The frontal plane range of motion of the MTJ. Also the range of motion of the first ray and the other rays.
9. The range of motion of motion of the MTJ in the sagittal and transverse planes.
10. The ankle joint dorsiflexion, active and passive, with the knee joint fully extended and again when flexed.
11. Posterior tibial strength
12. The presence of contracture of the hamstring muscles or the ilio-psoas muscle.
13. Any other signs of muscle weaknesses of the lower limb.
14. Signs of excess internal or external femoral or tibial torsion. Once we have this information, then deciding which procedure(s) are in the patient’s best interests will be much easier. Of course most practitioners would not advocate using surgery in lieu of orthotic therapy, but as an addition. Best wishes to the physician managing this case.
I recommend that the submitter of this case review my lecture at www.podiatry.com on Indications for Flatfoot Surgery.
Robert D. Phillips, DPM, Orlando, FL, Robert.Phillips9@va.gov
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