osteotomy

Epidemiology

Much less common than hip and knee OA
Patients tend to be younger

Aetiology

Trauma

RA

Rickets / osteomalacia

Issues

Horizontal joint line important

- < 10° tilt acceptable

> 10^o joint line tilt / due to femoral valgus

- continues to overload lateral compartment

Management Summary

Stage 0

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

Stage 1 / Normal X-ray, abnormal MRI

Forage: 80% G/E

Bisphosphonates

Stage 2 / Abnormal X-ray with cysts and sclerosis

A:  As for Stage I

Causes of Deformity

Metabolic Bone Disease

Paget's

Fracture Malunion

Previous Osteotomy

Options

1.  Intra-articular correction

2.  Simultaneous osteotomy and TKR

3.  Staged correction and TKR

1.  Intra-articular correction 

Indications

Femur

- draw line of mechanical axis of femur

Definition

Inflammation of achilles tendon; insertional or noninsertional

Spectrum

Tendonitis / Tendonosis / Rupture

Anatomy

Triceps surae

- medial and lateral gastrocnemius

- soleus

- surrounded by paratenon which allows gliding and supplies nutrition

Inserts middle 1/3 calcaneal tuberosity

- 2 x 2 cm area

- 90^o rotation distally

Retrocalcaneal bursa (x2)

Definition

Crushing osteochondritis of metatarsal head

Epidemiology

Usually 2nd metatarsal (80%)

- occasionally third

- can occur in any

Age 10-15 years

- peak 15 year old girls

- F:M = 3:1

- occurs during the growth spurt at puberty

Bilateral in 6%

Aetiology

Definition

Pain in the forefoot in the region of the MT heads

3 groups

1.  Localised

Morton's neuroma

Freiberg's

Stress fracture

Infection / tumour

Plantar Keratosis

Plantar Wart

2.  Systemic disease

RA