"PLANE FOOT IS WORTH"

By Hector Jose Lopez M.D.

 

      He finishes of plane foot I am worth it describes to the alteration unsightly tridimentional, characterized by the bad alignment of the articulations that you/they form the backfoot, the inbalance among evertores and invertores that result in residual bony deformities that you/they result in alterations in the mechanical axis, alterations of the march, callosities, pain, ulcerations and impossibility of adaptation to the footwear. 

      The method diagnosis of the plane foot is basically clinical since it consists of a series of characteristic only of this pathology, the interrogation and the physical exam they continue being important in the handling and classification of the plane foot (pain, broken foot, mensurations radiology, march laboratory.) 

      Among the most important x-rays they are since of front and profile with support the foot he/she should take the x-rays in bony functional position with load since a flexible plane foot without loads doesn't denote deformity.  Among the different angles the angle calcaneus floor, angle of Meari, angle calcaneus talus, the angle of covering of the head of the astragalus and the escafoides is to measure in the x-ray. 

       Different types of procedures have thought about for resolution of these deformities with changes and new handling methods the objective of this study it is to summarize the evolution of the different methods of handling of the plane foot I am worth flexible in spending of the years. 

        To be able to outline this objective we should contain the deformities for the different types of surgical correction being those but well-known: 

-correction of soft parts. 

-osteotomy. 

-artrorisis. 

-artrodesis extraarticular.  

-triple artodesis. 

 

Surgeries of soft parts: 

        Among the multiple resources of which count in the surgery proofreader of the foot, the procedures to soft parts are some of those that but variety finds and that with the coming of the studies and the patients' monitor with the resource of the march laboratory has taken a turn and an important orientation; among the different procedures we can mention: 

Elongation for slip of the tendon of Achilles: 

        Procedure this described by White in 1943; dedicated to correct a contractur miotatic of the triceps sural and this way reach an arch of dorsi passive flexion of the ankle helps to establish a new relationship tension-longitude (it curves of Blix). 

        It produces voluntary control and power of the muscle previous tibial. 

       Their indication is in equine of the foot with march in patient third rocker, bony, with capacity to stroll. 

Elongation of the twins with the technical Bulpius: 

        Bulpius and Stofer were the first ones in publishing works on the elongation of the fascia of the twins and their indication was for ostecondritis disecant with desprendimiento.The procedure it is not but that to make an incision in V invested by the fascia of the twins or two of those separated to 3 cms. 

        Technique of Baker:  coined by this in 1954 where toward an incision in OR invested by way of fluke in the central half of the aponeurosis of the twins they are liberated of the tendon of Achilles in the union miotendinosy and he/she is carried out dorsal flexion from 5 to 10 degrees to tear the cut fibers and s he/she sutures the borders of the torn section if the deformity of the equine one has not been corrected you can cut the central aponeurosis of the soleus. 

       Advance previous of the tendon of Achilles for correction of the spastic deformity of the equine one: 

        Technical descrtia for Murphy in 1974 which their basic principle is gives insert of the tendon of aquiles of its insert point in the later tuberosity of the calcaneus and it is transferred immediately from behind to the back of this bone of the articulation subastragalin it shortens this way the lever arm and he/she weakens the triceps sural without changing its longitude in rest. 

Lengthening muscle tendinosy for fractional slip of the tendon of the later tibial: 

         For deformities of I beach of the backfoot and the midlefoot for espasticity and contractur of the later tibial.  Consist two incisions very up where the muscular fibers finish in tendon forcing to take the foot in I am worth. 

         Long conversion of the extending one of the first finger for the tendon of the previous tibial and reduction of the muscle previous tibial: described by Thoen 1966. 

          It is indicated in patient with inability of voluntary control of the previous tibial for long contraction of the extending one of the thick finger and he/she consists on making union muscletendon of the extending one of the Ier finger in the previous tibial for three buttonholes made in the same one and you escrow the capsule of the insert of the previous tibial to shorten it. 

         Fractional elongation of the peroneos in their it united muscletendon: (chuinad, Peterson 1963) 

         In light deformities or moderated in I am worth backfoot and midlefoot in support bipodal for espastcity with contractur of the peroneus.   The procedure consists on a longitudinal incision in the later third from the one to leg the peroneos they are identified and two partial parallel courts are cut then he/she is given investment alpie to produce displacement of the segments hemisection. 

        Tranference  previous of the tendon long lateral peroneus to the base of the second metatarsiano: 

         Technique of of  green applied from 1957 used for patient with espasticity and paralysis in dorsal flexion of the foot. 

         This procedure consists on a simple technique in the one that you desinsert of the base of the 5to metartarso and it is transferred to the base 2do metarsiano it but possible distal. 

        Transfer previous tabial for the membrane interbone procedure of Green 1957, used for patient with pendulous march and deficiency of the dorsiflexores .  The procedure consist on desinsert the later tendontibial of their insert dital and he/she withdraws for an insition made proximal lukewarm wing and you tracciona this fillet tendinoso that produce is transferred by the membrane interbone  by the later compartment to the previous of the lukewarm one and it  notices the base of the 2 do metarsiany. 

Artrodesis: 

         Artrodesis extrarticular of the subastragalina (technique of Grice 1952) 

        Indicated in intense deformities in I am worth of the retropié with oblique or vertical astragalus, this surgery has as objective to correct the deformity in I am worth of the backfootand to restore the altitude of the longitudinal arch. 

       The procedure consists on make an incision on the subastragalina and the same one is identified the foot it is manipulated in position to equine and investment so the calcaneus rotates of its normal position behind the astragalus and the deformity is corrected of the I am worth the implant it is placed in the breast from the parallel tarso to the axis of the ankle and you artrodesys the subastragalin. 

        To advantage of the artrodesis extraarticulares is that they infer very little in the development of the foot but among the disadvantages and especially of this technique it is that he/she takes place requested of the mobility of the medial backfoot hindering the march in unequal land. 

      Strabilization of the articulation subastagalina for artroereisis with staples (method of Crawford 1990) 

        Their main function is correction of the astragalus vertical flexibl and in children with PCI and it consists on an insition of normal Cincinnati looking for the breast of the tarso in its roof and you proceeds to carry out  

        The reduction maneuver and a staple is placed in the astragalus calcaneus crossing the breast of the tarso. 

Artrodesis triple: 

        Their objective is the coalition of the articulation subastagalina getting lateral stability of the backfoot the first one in describing this technique it was Ryerson in 1923 and cosistia in the coalition of the subastragalina, calacaneus cuboidea and escafoidoastragalina. 

        The requirements for this procedure are that it is a foot with skeletal maturity 10 to 12 years all the sides’ articulares of the articulations they are already extracted mentioned and the agreement cuts are made the correction degree in the different planes. 

Artrodesis triple with implant incrusted technique of Williams and Menelaus. 

        The capsules of the articulations calcaneus cuboidea astragalus escafoidea and subastagalina open up and the osteotomy is made in the different plane articulars it takes bony tricortical and the bone triangle is placed in case I beach, I am worth or I dig excessive where the correction is required. 

       Osteotomy of Dwyer:   described of Dwyer in 1963 and used for I beach of the backfoot. it is carried out with the help of a cutaneous incision in the half line of the later prominence of the check it follows the pleats of the foot and it arrives to the border previous of the insert of the tedon of Achilles the osteotoma you sewed in carrying out a cut exactly at level of the calcaneus below the tedon of the long flexor of the 1 er finger it is left intact the courteous one lateral of the calcaneus but the other ones should be cut completely you medializa the calcaneus and bony implant is placed to eliminate the I beach. 

        Osteotomy of Mitchell: described in 1977 it consists on a line of court superior it leans down and before it is not made bore holes in the soft spongy fabric the cut it is carried out with a wide and right osteotomo and he/she moves back and the later fragment arrives and a nail steinmann is placed to fix the osteotomy. 

       Hoffer (1893): lengthening of the tendon of Achilles  

      Wilson and Paterson: (1905) I place the extending characteristic of the Hallux inside the channel in the escafoides. 

       Muller: (1903) tranfered the tendon of the tibial previous to the escafoides. 

 Artrorisis: 

        It is written by Grice to correct the I am worth of the check in the foot parality,  doing a blockade effect to articulate of the slip astragalino this model of Grice it has gone evolving and in our half current one you used expansion endortesis like it describes Gianini or the glass of TO. Viladot in luxacion of the astragalus escafoidea which it  are redutible manually. 

Osteotomias of the calcaneus:  

       The osteotomy midle of the calcaneus was described by Kkoutsogiannis in 1971, in patient with you disorder neuromuscule, which are too many youths for the triple artrodesis; maintaining the normal movement of the articulation and a to better function. 

        Lengthening of the calcaneus:  technique described by Evans 1961 described to the plane foot I am worth like a geometric deformity, that is to say a disparity among the external and internal column. 

        Vincent Fly:  (1995) it modifies the technique of Evans procedure which forces wing articulation subtalar to take a position but distal allowing the alignment of the medial column of the foot. 

        The osteotomy is at level of the calcaneus  approximate mind 10mm previous wing  calcaneus cuboide  looking for the parallel subastragalina to the calcaneus cuboidea, implant tricortical of crest iliac is placed with the purpose of to lengthen the external column of the foot and to shorten the intern. 

       This way we increase the complex of the articulation subastragalin and astragalus  escafoidea. 

        This procedure avoids playing the articulations of the foot therefore it maintains function and growth of the same one. 

Osteotomy  calcaneus  cuboidea  cuneana: 

       This technique was developed as answer to the problems of the artrodesis. 

Artrorisis: 

        Surgical procedure at level subtalar dedicated to correct the I am worth of the backfoot by means of the limitation of the movement. 

        Lelievre was the first one in using this technique with the help of staples. 

Artrodesis subtalar: 

        Technique of Bataidor (1968) I use an implant of cortical of fibula of 5 cms.  taking of the half third of the same one, subperiosticaly introduced it in the articulation subtalar. 

         In summary the plane foot is worth flexible it is an entity which has gone by a hard surgical evolution in the time, the important ones it is to be able to take and to leave each one of them according to the experience lived by the surgeon leaning on in the medicine based on the evidence without caring the surgical technique the best it is the one that they pass the test of the time and they bring satisfactory results to our patients.