PRESENTER:- DR. PARTH PATEL (M.S. ORTHO ASST. PROFESSOR) Abstract - PowerPoint PPT Presentation

PRESENTER:- DR. PARTH PATEL (M.S. ORTHO ASST. PROFESSOR) Abstract no.- 1131 Contact no.- +919426264600 CO-AUTHOR:- DR. NEEL PATEL (2 ND YEAR RESIDENT) DR. MALKESH SHAH (2 ND YEAR RESIDENT) GUIDED BY:- PROF. DR. J. J. PATWA(M.S. ORTHO) S.B.K.S.M.I.R.C ,PIPARIA, WAGHODIA, VADODARA, GUJARAT, INDIA.

CLOSE UP VIEW OF CALCANEOUS DEFORMITY AWKWARD GAIT

PLANTER FLEXOR SEQUALY PARALYSIS CALCANEOUS DEFORMITY OF LONG TOE FLEXORS POWERFUL ACT AS A SECONDARY DEFORMITY PLANTER FLEXOR SECONDARY CAVUS

CALCANEO CAVUS DEFORMITY SEQUALY IF TIBIALIS POSTERIOR ALSO PARALYSED OF CALCANEO CAVO VALGUS DEFORMITY LOSS OF PUSH OFF PHASE DEFORMITY OF GAIT AWKWARD AND DIFFICULT GAIT

TREATMENT IS DIFFICULT BEACAUSE  LACK OF SUITABLE TENDON FOR TRANSFER  NEED CORRECTION OF EXTREME DEFORMITY SURGERY IS MANDATORY AS EARLY AS POSSIBLE EVEN IN SKELETALLY IMMATURE PATIENT  TO HALT PROGRESSION OF DEFORMITY  TO RESTORE THE POWER OF PUSH-OFF  IN SKELETALLY MATURE PATIENT FOOT CORRECTION DONE BY DIFFERENT TYPES OF BONY SURGERY LIKE GRICE GREEN EXTRA ARTICULAR FUSION

FAILURE DUE TO  TOTAL PARALYSIS OF PLANTAR FLEXORS  PERONEOUS LONGUS IS WEAK

AS PER CAMPBELL THEY PUT DOUBLE INCISION SO CHANCES OF DEVELOPMENT OF FAT NECROSIS IS MORE AND THAT IS WHY WE PUT ONE CONTINEUOUS POSTERO – LATERAL INCISION OVER ANKLE AND FOOT

OUR CONTINEUOUS POSTERO- LATERAL INCISION

Principle

Peroneus longus tendon dissected

In our technique we avulse the whole heel on medial side and expose calcaneal tubercle

A posterior and plantar slot is made over the tubercle of calcaneum

By button hook pull peroneus longus brought under the slot to convert everter in plantar flexor without disturbing origin and insertion

Lock peroneal tendon in slot

Few sutures are taken over the tendon From soft tissue over plantar and posterior aspect to prevent popped out of tendon

Peroneal sheath closed over the peroneus brevis

Heel is placed in its original position and wound closed rest given for 3 weeks under plaster

Along with this operation extra articular fusion can be Fibular graft done for preventing valgus Grice green operation

CRITERIA FOR RESULT  Power and R.O.M. of plantar flexion  R.O.M. and its lag of dorsiflexion  Pattern of push off phase of walking  Weight bearing capacity over head of the metatarsals  Maintenance of balance between dorsiflexors and plantar flexors  Improvement of gait

RESULT Cases operated 58 Excellent 30(60%) Lost to follow up 08 Good 10(20%) >2 yrs. Follow up 50 Poor 10(20%) COMPLICATION Skin edge necrosis in 8 cases & Restricted dorsiflexion in 8 cases DISADVANTAGES Occasional skin edge necrosis, mild eqinus deformity and in absence of long toe flexors power of plantar flexor is not balanced with dorsiflexors

ADVANTAGES  No need of any sutures or implants  No need of waiting for starting of physiotherapy for new insertion to take the Place  Peroneous muscle gradually hypertrophied on use  Open steindler’s procedure for cavus deformity can be done at a same stage  With minimal dissection “Grice Green” extra -articular fusion can be done at same time  No double incisions or underwining of skin flap so chances of skin necrosis is less  Agonistic tendon selected which always give better power  Long lever arm acting via lever of tuberosity of calcaneum on short lever arm so with less power one will get better planter flexion  Improved push off of walking  It halt calcaneous deformity