Foot

Definition

Osteonecrosis of the navicular

Epidemiology

Present at age 4-6 years

- same as Perthes disease

M:F 5:1

Bilateral in 20%

Aetiology

Repetitive trauma to maturing ossific nucleus

Region specific approaches

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

Lower Limb

Thigh

Principles

Foot

A little equinus is better than calcaneus

A little valgus is better than varus

A little varus is better than severe valgus

TA lengthening is most over used operation in CP

Knee

A little knee flexion is better than recurvatum

Knees

Problems

Tight hamstrings 

Look

Aids

Shoes - raises / wear patterns

Stigmata generalised disease

Hands - RA, CMT

Front

Knee alignment

Forefoot - Hallux & Lesser toes 

Scars

Circulatory changes

Medial Side

Turn affected side away & ask to step foot forward

Flexed attitude of knee

Medial arch - planus / cavus

Mechanism

TCC’s heal ulcers by reducing pressure

- 1/3 of load is taken by wall of cast & transmitted to the leg

- 45% reduction in forefoot pressure but not heel pressure

Definition

Neuropathic Arthropathy

Progressive destructive arthropathy 2° to neurological condition

- usually minimal to no trauma

Aetiology