Flexible Flat Foot
Symptoms
Complain of pain with prolonged standing
Complain feet tire easily
Examination
Overall alignment
Heel raises
Complain of pain with prolonged standing
Complain feet tire easily
Overall alignment
Heel raises
1. Persistent instability despite ORIF and LCL repair
2. Gross acute instability, not suitable for surgery
3. Delayed treatment > 4 weeks
Young men
FOOSH
- axial load, dorsiflexion and radial deviation
DISI occurs in ulna deviation
Type A Stable acute fracture
A1 Tubercle
Convincing association with development of osteoarthritis
- arthritic changes beginning at radial styloid
- progress to scaphocapitate & capitolunate
Type I - Boutonniere
- commonest
- MP flexion / IP hyperextension
- usually EPB rupture with EPL subluxation
Type II
- Boutonniere & Swan Neck
- doesn't exist according to Nalebuff
1. PIPJ Synovitis
- synovectomy via dorsomedial approach
2. Flexor tenosynovitis
- may cause trigger finger
- trial HCLA
- remove synovits but don't release A1 pulley
- will worsen ulna drift
3. DIPJ
- rarely affects
Scapho-lunate advanced collapse
- caused by malalignment of scaphoid on radius
- due to scapholunate disruption
Most common cause of wrist OA
1. Radio-scaphoid degenerative changes
- from abnormal flexion of scaphoid
Massive tear
1. > 5cm
- retracted to humerus / glenoid margin
2. At least 2 complete tendons
- lose SS / IS or SS / SC
Rare
- 2% of acute dislocations
Often missed
- < 1/ 52 25%
- < 6/52 25%
- < 6/12 25%
- > 6/12 25%
Traumatic initial cause in 95%
M:F 2:1
Age of initial dislocation inversely related to recurrence rate
- patients younger than 20 have a redislocation rate of 90%
- between 20 - 40 years, redislocation rate of 60%
- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)