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Kristen Biel
Eric Gervelis
Sean Hodson
Patient History
25 y.o. male PTC with pain in heel.
N - sharp, nagging pain
L - medial and lateral sides of heel
D-?
O-?
C-?
A - pain increases when on his feet for
prolonged periods of time
T-?
S - “reconstruction of left foot and ankle” for
treatment of flatfoot
History (continued)
RCSP 4 EV 6EV
NCSP 0 4 EV
Tibial Influence 4 EV 6 EV
D/DX before X-rays
Iatrogenic
Infection secondary to internal fixation
Self induced – walked on foot too early after SX
AVN of calcaneus
Stress Fx
Arthritis
STJ Coalition
Plantar Fasciitis
Radiography Findings of Left Foot
ST – slight edema ankle, left>right
Bone - Well healed fusion (sclerotic line) of
calcaneal osteotomy with partial threaded
cancellous screw which is not purchasing the
bone, “backing out”
Bone - Talar beaking, Os trigonum, and
hypoplatic fibular sesamoid
Joint - Well healed fusion of TN jt with cortical
screw
Joint - Bony fragments between 1st CN jt, lack of
screw purchase
Radiography Findings of Both Feet
Toe Rocker
Heel Rocker
Forefoot Rocker
Double Rocker
Heel to Toe Rocker
Recommendation
Heel to Toe Rocker
Recommendations
LisFranc’s Rocker
Surgical Correction
SX – clean the necrotic bone from the 1st CN jt, and insert a base
wedge osteotomy (allogenic from a bone bank or allograft) between
the 1st CN jt and fuse – this will raise the medial arch.
The Ganley and Ganley open base wedge procedure can also be
done to lengthen and raise the medial column in the 1st cuneiform,
and possibly shorten the lateral column with a closed wedge
procedure if the foot is rigid – however this is probably not the 1st
choice for our pt.
A – Peabody and Muro. B – McCormick and Blount. C – Steytler and Van Der Walt,
D – Berman and Gartland procedure – good for meta adductus of residual clubfoot
and also congenital metatarsus varus
Orthoses
Depending on his ROM after surgery, functional
orthoses may be in order for the ideal patient.
However, our patient will probably still need a
pronated device, with or without an AFO. The
nucleated HPK and any incisions should first be
healed.