Name:
Correction of Plano Valgus Foot Deformity (Brief)
Description:
Correction of Plano Valgus Foot Deformity (Brief)
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/da805cef-4657-4210-9cf6-f8a4ba69d710/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H06M37S
Embed URL:
https://stream.cadmore.media/player/da805cef-4657-4210-9cf6-f8a4ba69d710
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/da805cef-4657-4210-9cf6-f8a4ba69d710/4_ Correction of Plano Valgus Foot Deformity (Brief)- v1 - b.mov?sv=2019-02-02&sr=c&sig=D3GcE4uvdOBixUvq7QGDKlOZYFX2EC8Lu9CORtWBAYg%3D&st=2024-11-23T11%3A32%3A24Z&se=2024-11-23T13%3A37%3A24Z&sp=r
Upload Date:
2024-06-01T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
JONATHAN DELAND: Hello. My name is Jonathan Deland. Patient in his early 20's with very severe heel valgus as well as abduction. In this age group, the posterior tibial tendon has not failed and therefore no tendon transfer is necessary. In later ages, such as in the fifties, sixties, the patient with severe plantar valgus foot will have posterior tibial tendon insufficiency commonly and of course attendant transfer will be necessary.
JONATHAN DELAND: This is the AP view of the foot showing the abduction. Look at the talonavicular joint and the exposure of the medial talar head. On the lateral view, actually not so bad, there is elevation of the first ray if you look carefully and also a low calcaneal pitch. Here is the heel line. If you look at how much valgus there are in both of his heels particularly the left, this is a very severe
JONATHAN DELAND: heel valgus, that's where he needs the most correction. This is the gastrocnemius. I've found the interval, I'm now palpating the gastroc tendon below, soleus above. Now we're debriding the first metatarsal tarsal joint doing thin saw cuts just to correct the angle without significant shortening. Taking out the fragment of bone,
JONATHAN DELAND: here's the second cut. Now we're at the posterior calcaneus osteotomy going along the pins that I put in direct it. This is a crosshatch just to see my position proximally distally once the osteotomy is mobilized. We're now finishing the cut, spreading it to mobilize the soft tissue, we're now finishing the reduction of the first metatarsal effusion.
JONATHAN DELAND: Now we're doing the dissection for the anterior calcaneal osteotomy exposing the sinus tarsi. We're doing a special dissection here just on the other side of the peroneal tendons and sural nerves so we've created a soft tissue window to create the back posterior vertical limb window. So when we need to use a saw there, we can just retract the peroneal tendons anteriorly or dorsally.
JONATHAN DELAND: Here's that shot of the heel I've reviewed, it gives us a good sense of how much correction of the heel he needs, which is a very large amount. That is why we're placing the screw, which I found helpful in very severe cases where we have to move a lot here, we're moving like 16 millimeters medially. I judge the position by this kind of view clinically.
JONATHAN DELAND: We're now pinned it in the reduced position, we're just removing the prominent lateral bone. I'll also go back and burr the little ledge that's left so there's, so there's just a smooth area and there's really no impingement on this skin. Now we're back at the anterior calcaneal osteotomy site. We have retracted the soft tissues. This is showing the length that we're marking out.
JONATHAN DELAND: The step cut a centimeter back from the joint and putting a pin where proximal and distal portions of the horizontal limb are. I'm going to mark the depth of the saw blade according to what the pins showed us, so I have a sense of how deep the saw should go. So you want to be careful going across and just cut the medial cortex techs and not beyond. Now doing the vertical limbs of the osteotomy,
JONATHAN DELAND: I'm going to use the window now to finish the posterior vertical limb with retractors in place to protect the soft tissues. Then we're going to place this distractor in to distract our osteotomy, once we know that it's been mobilized and we're going to try different wedges, widths and determine how much correction. The correction is primarily determined by getting good clinical alignment, yet maintain adequate eversion motions so that the patient does not have too much stiffness or lateral weight bearing.
JONATHAN DELAND: I check the heel and the first metatarsal tarsal joint to make sure they're good and once all three osteotomies are fixed, and then I go and start fixing. So now I'm going to fix first, the first metatarsal tarsal fusion with a 3.5 screw proximal to distal and then a 4.0 screw again cortical both placed in the lag mode to compress this very well. This, along with the flat cuts, has given us a very high rate of fusion.
JONATHAN DELAND: This is the over drilling for the lag effect. Just, just measuring the screw and then placing the 4.0 again with good compression, which you can see here. Will now next go fix the heel with 4.5 screws so they're not too prominent. Now we've cut the tri cortical graft for the anterior or lateral column lengthening site.
JONATHAN DELAND: There's the graft being put in place. We put the anterior vertical limb in graft first, making sure it's a snug fit, checking all four corners with a blade. Now we got excellent apposition on the top and sides, and you also check the correction. Now we place these two pins which are going to end up being screws. The first one fixed is the one going from the anterior calcaneus,
JONATHAN DELAND: from distal to proximal, basically parallel with the horizontal limb and we'll capture the graft on the top or the anterior vertical limb. Now we're putting in the graft in the posterior vertical limb. Now we're trimming, just trimming the graft on the top, making sure it was not too prominent and again making sure it's stable, and I can confirm that it's good eversion motion, good alignment of the heel. Here the post-operative view's a better reduced talonavicular joint but not over reduced.
JONATHAN DELAND: On the lateral view, we see a little bit higher calcaneal pitch and the first ray is now down, good position of the talonavicular joint. Here is the correction of the heel, notice how much correction we have gotten? A lot. The heel is now really basically right underneath the tibia and good alignment with the tibial shaft.
JONATHAN DELAND: This patient has done very well clinically because we did not over or under correct him. He has actually come back for his second foot and can walk comfortably and is able to do sports. We've corrected the hind foot with the posterior calcanealosteotomy, the midfoot with a lateral calm lengthening being careful to preserve eversion motion and also to bring the first ray down. A cotton osteotomy for the medial canaliform is an alternative to the first metatarsal tarsal effusion
JONATHAN DELAND: but in cases with a lot of elevation, the first metatarsal tarsal effusion is more effective. We have then aligned the three parts of the foot and yet retained the essential motions. Thank you.
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