Flatfoot cases

Marino Delmi
EFAS President
Geneva - Switzerland
www.efas.co.uk
1
 Woman 66 years old
No significant medical history
Pain and deformity of left foot for 2 year
www.efas.co.uk
2
 3
www.efas.co.uk
 4
www.efas.co.uk
 5
www.efas.co.uk
 6
www.efas.co.uk
 7
www.efas.co.uk
 8
www.efas.co.uk
TREATMENT ?
9
www.efas.co.uk
 1) flexible hyperpronated
foot with
dominant hindfoot valgus
www.efas.co.uk
10
 Correct the VALGUS !
www.efas.co.uk
11
 1) flexible hyperpronated
foot with
dominant hindfoot valgus

medial
displacement
calcaneal osteotomy
(MDCO)
works in the frontal
plane
(Gleich 1893,
www.efas.co.uk
12

Myerson 1993)
www.efas.co.uk
13

Tir de Gould JS, Operative

Foot Surgery, 1994.
14
www.efas.co.uk
 Medial displacement OT

combined with FDL transfer,

medial capsule plication
www.efas.co.uk
15

Myerson & Corrigan, Orthopedics, 1996

Guyton et al. , Foot Ankle Int, 2001
 2) compensation mainly in the transverse
plane
flexible hyperpronated
dominant forefoot abductus
www.efas.co.uk
16
 2) compensation mainly in the transverse
plane
flexible hyperpronated
dominant forefoot abductus
www.efas.co.uk
17
 Osteotomy Evans
(reversed)

Evans D, JBJS, 1975

www.efas.co.uk
18
19
www.efas.co.uk
www.efas.co.uk
20

Important deformity in Transverse

plane
 Osteotomy 10 mm from CC joint
open wedge - graft - internal fixation
combined with medial reconstruction

4mm

1 cm
www.efas.co.uk
21
22
www.efas.co.uk
23
www.efas.co.uk
 Overall indications according to Bluman
staging

Definition
Aetiologies
Stage 3
Pathomechanics
Pathoanatomy
Classification
Hindfoot arthrodeses with
Treatment malalignment correction
www.efas.co.uk
24
 Stage 3
Triple arthrodesis
www.efas.co.uk
25
 Stage 4: involved ankle
pantalar fusion
www.efas.co.uk
26