Tibialis Posterior Reconstruction for pes planus
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The operation described using a Flexor Digitorum Longus(FDL) transfer, spring ligament plication and medialising calcaneal osteotomy is the classic reconstruction for a grade 2 (flexible ) flat foot due to Tibialis Posterior dysfunction.
Tibialis Posterior dysfunction is typically a condition of middle age and onwards in which conservative management with orthotics and physiotherapy is usually the first line of management and often successful (in approximately two thirds of cases).
Surgical correction of the flexible flat foot using the FDL transfer with calcaneal osteotomy (and other procedures) results in high patient satisfaction rates and symptomatic relief but with a slightly lower incidence of maintained correction of the pes planus deformity. A proportion of patients, though improved, still require the use of a corrective orthotic.
Author: Mark Herron FRCS.
Institution: The Wellington Hospital , London
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Question 1 of 20
which one of the following best describes the primary action of tibialis posterior ?CorrectIncorrect
Question 2 of 20
which one of the following structures is not a static restraint of the hindfoot ?CorrectIncorrect
Question 3 of 20
Which one of the following structures does not receive an insertional attachment from the tibialis posterior tendon?CorrectIncorrect
Question 4 of 20
Which one of the following is not a risk factor for developing tibialis posterior tendinosis ?CorrectIncorrect
Question 5 of 20
Which one of the following operations is not appropriate as part of the primary operative treatment of a flexible pes planus deformity due to disease of the tibialis posterior tendon ?CorrectIncorrect
Question 6 of 20
In which one of the following positions is tibialis posterior power most reliably tested ?CorrectIncorrect
Question 7 of 20
Which one of the following descriptions best defines a grade 2 tibialis posterior tendinosis in the Johnson and Strom classification ?CorrectIncorrect
Question 8 of 20
Which one of the following is a contra-indication to a flat foot correction including an FDL transfer and calcaneal osteotomy?CorrectIncorrect
Question 9 of 20
Which one of the following disorders is not associated with an inability to single heel raise?CorrectIncorrect
Question 10 of 20
The extended lateral approach utilises which one of the following angiosomes in order to reduce the risk of wound complications?CorrectIncorrect
Question 11 of 20
Which one of the following structures is not directly at risk when performing a calcaneal osteotomy?CorrectIncorrect
Question 12 of 20
Which one of the following best describes the clinical findings in a patient with a grade 3 tibialis posterior tendinosis defined by the Johnson and Strom classification?CorrectIncorrect
Question 13 of 20
Which one of the following is true of the skin incision used in the medial approach for a Flexor Digitorum Longus transfer for pes planus?:CorrectIncorrect
Question 14 of 20
Which one of the following is true of a tight Achilles tendon ?:CorrectIncorrect
Question 15 of 20
Which one of the following is not an appropriate point of attachment for the FDL tendon transfer ?:CorrectIncorrect
Question 16 of 20
Which one of the following additional procedures is always required with the Flexor Digitorum Longus transfer?CorrectIncorrect
Question 17 of 20
If reconstructing the Spring ligament which one of the following is correct ?CorrectIncorrect
Question 18 of 20
With respect to the post-operative period after Calcaneal osteotomy and Flexor Digitorum Longus transfer which one of the following statements is correct ?:CorrectIncorrect
Question 19 of 20
Which one of the following is not true of the published results for patients undergoing surgical correction of a grade 2 Tibialis posterior deformity ?:CorrectIncorrect
Question 20 of 20
Which one of the following statements is true when inserting an arthroereisis screw for grade 2 tibialis posterior tendinosis?CorrectIncorrect