subtle cavus in sports injuries - foreonline.org€¦ · 12.02.2018 · foot scientific-3™...
TRANSCRIPT
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SUBTLE CAVUS IN SPORTS INJURIES
MICHAEL P. CLARE, MDFLORIDA ORTHOPAEDIC INSTITUTE
TAMPA, FL USA
NON-NEUROMUSCULAR ∅NORMAL VARIANT: 20-25% INCIDENCE
∅ LEDOUX, ET AL. FAI 24, 2003
∅ FOREFOOT-DRIVEN / MORE SUBTLE
NORMAL GAIT CYCLE∅HEELSTRIKE TO MIDSTANCE
∅HINDFOOT EVERSION
∅ CHOPART JOINTS UNLOCKED∅ AXES OF JOINTS PARALLEL
∅MIDFOOT FLEXIBLE / SUPPLE∅ SHOCK ABSORPTION MECHANISM
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NORMAL GAIT CYCLE∅ TERMINAL STANCE TO TOEOFF
∅HINDFOOT INVERSION∅ POSTERIOR TIBIAL TENDON
∅ CHOPART JOINTS LOCKED∅ AXES OF JOINTS NON-PARALLEL
∅MIDFOOT FIXED / RIGID∅ LEVER FOR FORWARD PROPULSION
HINDFOOT ALIGNMENT∅ INFLUENCE ON HINDFOOT MOTION
∅ AMINIAN & SANGEORZAN, FA CLIN 13, 2008
VALGUS NEUTRAL CAVUS
PATHOMECHANICS∅NO HINDFOOT EVERSION
∅ CHOPART JOINTS REMAIN LOCKED
∅NO SHOCK ABSORPTION
∅ CORONAL PLANE STRESSES ABSORBED BY ANKLE JOINT
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FOREFOOT-DRIVEN CAVUS
∅ PLANTARFLEXED 1ST RAY
∅ KICK-STAND EFFECT ON TRIPOD
∅HINDFOOT EVERSION BLOCKED
KICK-STAND EFFECT ON TRIPOD∅ KRAUSE, ET AL. JBJS 89-B, 2007
∅ VARUS THRUST THRU ANKLE JOINT
KICK-STAND EFFECT ON TRIPOD
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LATERAL COLUMN OVERLOAD
∅ COURTESY TC FITZGIBBONS, MD
ASSOCIATED SEQUELAE
∅ CHRONIC ANKLE INSTABILITY
∅ PERONEAL TENDON PATHOLOGY
∅ S-AD DISTAL TIBIAL STRESS FX
∅NAVICULAR STRESS FX
∅ACCELERATED ANKLE ARTHRITIS
ASSOCIATED SEQUELAE
∅ 5TH MT FX / JONES FX
∅ 4TH / 5TH MT STRESS FX
∅ 1ST / 5TH MT HEAD CALLOSITIES
∅ LATERAL COLUMN OVERLOAD
∅ SESAMOIDITIS
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STANDING EXAMINATION∅ VIEW BACK TO FRONT / FRONT TO BACK
∅ COURTESY TC FITZGIBBONS, MD
PEEK-A-BOO HEEL SIGN∅ BEALS & MANOLI, FOOT ANKLE 6, 1996
COLEMAN BLOCK TEST∅ COLEMAN & CHESNUT, CORR 123, 1977
∅ 3/4” BLOCK
∅ LEAVE 1ST RAY OFF BLOCK MEDIALLY
∅ASSESS HINDFOOT FROM BACK TO FRONT
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FOREFOOT-DRIVEN CAVUS
∅HINDFOOT FLEXIBLE / REDUCES TO NEUTRAL
∅ PLANTARFLEXED 1ST RAY CAUSING VARUS
HINDFOOT-DRIVEN CAVUS
∅HINDFOOT FIXED / DOES NOT REDUCE / RESIDUAL CAVUS
∅HINDFOOT CAUSING VARUS
TIBIOFIBULAR OVERLAP
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CALCANEAL PITCH ANGLE
MORE POSTERIOR FIBULA∅ SCRANTON, ET AL. FAI 25, 2004
MEARY’S ANGLE
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METATARSAL STACKING∅ FOREFOOT SUPINATION /
ADDUCTUS
TREATMENT∅MANOLI & GRAHAM, FAI 26,2005
∅HIGH FAILURE RATE / RECURRENCE IF CAVUSNOT ADDRESSED
CAVUS FOOT ORTHOTIC
∅ LATERAL HEEL & SOLE WEDGE
∅ 1ST MT HEAD RECESS
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ARCH RIVAL™∅ PREFABRICATED CAVUS ORTHOTIC
∅ COMBINED WITH PTX/BRACE/SURGERY FOR ASSOCIATED CONDITION
FOOT SCIENTIFIC-3™∅ PREFABRICATED CAVUS ORTHOTIC
CAVUS DEFORMITY CORRECTION
∅ INDIVIDUALIZE BASED ON DEFORMITY
∅ TREAT ASSOCIATED CONDITION
∅ CHILVERS & MANOLI, FA CLIN 13, 2008∅MANOLI & GRAHAM, FAI 26,2005∅ FORTIN, ET AL. FAI 23, 2002
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TEXTBOOK CAVUS CORRECTION
∅ P-LONGUS TRANSFER TO P-BREVIS∅ PF FORCE ON 1ST RAY / PL OVERDRIVE ∅ PRESERVE EVERSION STRENGTH
∅ DORSIFLEXION 1ST MT OSTEOTOMY∅ELIMINATES KICK-STAND EFFECT OF 1ST
RAY BLOCKING HINDFOOT EVERSION
∅ LATERALIZING CALCANEAL OSTEOTOMY∅ELIMINATES VARUS THRUST THRU ANKLE
SUBTLE CAVUS IN ATHLETES
∅ TREAT ASSOCIATED CONDITION
∅ CAVUS ORTHOTIC FOR ALL SPORTS
LIMIT CAVUS CORRECTION TO REVISION CASES IN ATHLETES
∅ FOREFOOT-DRIVEN: DORSIFLEXION 1ST MT OSTEOTOMY
∅HINDFOOT-DRIVEN: LATERALIZING CALCANEAL OSTEOTOMY
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CASE 1
CASE 1: HISTORY∅ 17M BASKETBALL PLAYER
∅ SEVERE ANKLE SPRAIN 7 MO AGO
∅ULTIMATELY DX: OSTEOCHONDRAL FX
∅ TX NON-OPERATIVELY
∅ STILL UNABLE TO PLAY / LOCKING SX
CASE 1: EXAM∅ STABLE LIGAMENTOUS ENDPOINT
∅ POINT TENDER ANTEROLATERAL JNT
∅ TENDER AT EXTREME ANKLE DF
∅ SUBTLE CAVUS ALIGNMENT
∅ CORRECTS ON COLEMAN BLOCK
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CASE 1
CASE 1
CASE 1
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CASE 1: DIAGNOSIS ?
∅OSTEOCHONDRAL FX / LOOSE BODY
∅ KISSING LESION OF VAN DIJK (FROM LOCKED HINDFOOT)
∅ SUBTLE CAVUS FOOT
CASE 1: TREATMENT
∅OPEN EXOSTECTOMY TIBIA / TALUS
∅ LOOSE BODY REMOVAL / MICRO-FX
∅ CAVUS ORTHOTIC FOR SPORTS
CASE 1
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CASE 1
CASE 1
CASE 1
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CASE 1
∅NWB X 4 WEEKS
∅ PTX / PROGRESSIVE WB
∅ CLEARED TO RETURN TO PLAY @ 4 MO
CASE 1: FINAL
CASE 2
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CASE 2
∅ 18F / D-1 COLLEGE SOCCER COMMIT
∅ 5TH MT FX TX NON-OP / BONE STIM
∅ RE-INJURY 2 WKS AFTER BEING CLEARED TO RESUME ACTIVITY
∅MINIMAL TRAUMA
CASE 2
CASE 2
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CASE 2: DIAGNOSIS
∅ ZONE 3 FX / RE-FRACTURE
∅ COMPETITIVE ATHLETE
∅ SUBTLE CAVUS / ADDUCTUS
CASE 2: TREATMENT
∅ORIF 5TH MT
∅ CAVUS ORTHOTIC FOR SPORTS
CASE 2
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CASE 2
CASE 2
∅ CAVUS ORTHOTIC
∅ CLEARED TO RETURN TO PLAY @ 4 MO
∅ CARBON/STEEL SHANK FOR CLEAT
CASE 2: AFTERMATH
∅MILD PAIN AT SCREW TIP / RUBBING ON SOCCER CLEAT
∅ “YOU NEED TO HAVE THE SCREW REMOVED NOW BEFORE MORE BONE GROWS OVER IT…”
∅ SCREW REMOVAL
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CASE 2: AFTERMATH∅ RE-FRACTURE WALKING ON CAMPUS
∅ REVISION ORIF
CASE 2: AFTERMATH
SUMMARY∅NON-NEUROMUSCULAR VARIANT
∅~20% INCIDENCE IN POPULATION
∅ COMPLEX PATHOMECHANICS
∅ PRODUCES VARUS ANKLE THRUST / LATERAL COLUMN OVERLOAD
∅MANY ASSOCIATED SEQUELAE
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SUMMARY
∅ COLEMAN BLOCK TEST
∅ TREATMENT OF ASSOCIATED CONDITION / CAVUS FOOT ORTHOTIC
∅ RESERVE CAVUS CORRECTION FOR REVISION CASES IN ATHLETES
∅ DF 1ST MT OSTEOTOMY (FF-D) / CALCANEAL OSTEOTOMY (HF-D)