Diseases of the foot Rozkydal. Z. Noha-skelet 3 Anatomy Obr. 1 Art. talocruralis Art. talocalcanearis Art. Choparti Art. Lisfranci Art. metatarsophalangealis Art. IP proximalis Art. IP distalis Niha-skelet 4 Anatomy Obr. 2 Art. talocruralis Art. talocalcanearis Art. Choparti Art. Lisfranci Art. metatarsophalangealis Art. IP proximalis Art. IP distalis Noha- skelet 1 Anatomy Obr. 3 Noha skelet 2 Anatomy Obr. 4 noha- svaly dorsum Anatomy Obr. 5 Vaginae mm. extensorum pedis noha- svaly later Anatomy Obr. 6 Vaginae mm. peroneorum noha- svaly med Anatomy Obr. 7 Vaginae mm. flexorum pedis noha- plant Anatomy Obr. 8 Aponeurosis plantaris noha- svaly planty Anatomy Obr. 9 Flexors noha- svaly plantárně Anatomy Obr. 10 Flexors The ankle joint Synovialitis Osteoarthrosis Trauma Posttraumatis conditions Static deformities Congenital deformities Rheumatoid arthritis Osteochondrosis dissecans - talus Stenosing tenosynovitis Tarsal tunnel syndrom Noha- rtg hlezna N synov N synov Synovialitis Zevní koll Lateral ligaments Sprain Partial rupture Complete rupture Obr. 12 Lig. collaterale lat. Držený rtg snímek X- ray Obr. 13 hlezno- držené rtg Management Sprain: bandage, othesis Partial rpt.: orthesis, plaster Complete rpt.: suture and plaster Obr. 14 Watson-Jones plastika Obr. 15 Evans plasty Watson Jones plasty Chronic instability Osteochondrosis tali Osteochondrosis dissecans tali Obr. 16 Hlezno- diss Noha- zrůstková 2 Noha- zrůstková 1 Arthritis of the ancle joint Obr. 18 Noha- zrůstková1a Noha- zrůstková 2a Arthrodesis Adams- Horwitz arthrodesis Noha déza hlezna charnley Charnley arthrodesis Noha - TP hlezna Total ankle replacement Obr. 21 Sy tarzálního tunelu Tarsal tunnel syndrom Sy tarz Obr. 22 Obr. 23 Ploska nohy - inervace Tarsal tunnel syndrom Innervation of plantar side Sy tarz Peroneal tenosynovitis noha- svaly later Pes planus- flat foot Congenital flat foot Rigid: Vertical talus Tarsal coalition Flexible: pes calcaneovalgus Noha- talus verticalis 2 Noha- talus verticalis 1 Vertical talus Flat foot Acquired flat foot Laxicity Marfan sy, Ehlers- Danlos sy, Down sy Cerebral palsy, myopathies Rheumatoid arthritis Noha- pes planus 2 Noha- pes planus 2 Flat foot 1. Diminished arch 2. No arch 3. Arch convex plantarwards noha Valgozita paty Valgosity of the heel Flat foot 3. degree flat foot Noha- pes planus 2 Noha In small children - pes planovalgus 3-6 years Weak muscles of the calf Valgosity of the heel Talus is medialy and plantarwards Subluxation of navicular bone Noha Symptoms: Asymptomatic Fatique Contractures of the muscles Pain in the calf Noha In small children - pes planovalgus Management 1.-2. stage 1. Exercise Good shoes Firm heel Barfoot walking Not to overload Stretching of m. triceps surae Noha Management 3. stage Supports noha- vložky Noha- vložka Noha- vložka 2 Os tibiale externum Noha- os tibiale extern 1 Noha- os tibiale ext 2 Can lead to the flat foot N os tib e Peroneal spastic flat foot Tarsal coalition Vrozené vady- koalice nohy Vrozené vady- koalice nohy noha- formule Types of the foot a quadratic b greece c egyptian Obr. 50 Flat foot in adults Noha- pes planus 2 Diminished weight bearing Good shoes Physiotherapy Supports Surgery- triple arthrodesis Noha- RST 1 Transverse flat foot Noha Normal arch of metatarsal heads Arch of metatarsal heads in transverse flat foot Pes transversoplanus Prominence of metatarsal heads Callosities N PT Noha pes transversoplanus 2 Transverse flat foot Noha Management Diminished weight bearing Good shoes Physiotherapy Supports Surgery Noha pes transversoplanus 2 noha Weil osteotomy N weil 1 N weil 2 noha- helal Helal osteotomy Noha- Helal Noha- Volf Obr. 53 Wolf osteotomy Surgery Noha - resekce hlaviček MTT Resection of metatarsal heads Noha resekce hlav Hallux valgus- bunion Noha - hallux valgus klin Hallux valgus rtg Surgery Soft tissues Osteotomies Resection arthroplasty Arthrodesis Joint replacement Hallux valgus rtg Obr. 61 Noha- Mc Bride Mc Bride procedure noha- chevron Chevron osteotomy Osteotomy of the first metatarsal N mc bride N Mc bride 3 noha- chevron Obr. 64 Scarf osteotomy Osteotomy of the first metatarsal N scarf 3 N scarf 1 N scarf 2 Hallux valgus Op. sec. Lapidus N pamět svorky N pamět svorky Noha- osteotomie baze 1 MTT Proximal osteotomy of the first metatarsal N baze 1 Hallux valgus - Keller Op. sec. Keller – resection arthroplasty Hallux valgus - Mc Bride Obr. 67 Obr. 68 Hallux rigidus Noha- dna Arthrosis art. MTPh. I. N rigidus 1 N rigidus 2 N rigidus 3 Artrodesis of the big toe Noha - déza palce 1 Artrodesis of the big toe Noha déza palce 2 Obr. 69 Obr. 70 N TEP 2 N TP 1 Replacement of the first metatarsal joint Deformities of the foot Boha- deformity nohy Pes varus Pes valgus Pes cavus Pes equinus Pes calcaneus Pes equinovarus Obr. 73 Noha- RST 1 Triple arthrodesis Ryerson Obr. 74 Noha- RST 2 Noha - RST 3 Triple arthrodesis- modifications Obr. 75 Dunn Obr. 76 Hoke Noha- Lambrinudi Obr. 77 Lambrinudi Triple arthrodesis Noha - pes equinus Noha pes equinus rtg Pes equinus- drop foot Obr. 78 Obr. 79 Noha Correction of the drop foot by triple arthrodesis Obr. 80 Noha- RST rtg Triple arthrodesis for pes cavus Preop. Postop. Noha- RST rtg Tripple arthrodesis - pes equinovarus Talipes clubfoot Vrozené vady- PEC resekce sub talo noha- Grice Correction of deformity of the foot in children Grice extraarticular arthrodesis Noha- Vulpius Obr. 88 Vulpius Noha-Strayer Obr. 89 Strayer Prolongation of Achillis tendon Dig Deformities of the toes mallet toe flexed toe flexed DIP joint N DH 1 N dig maleus Kladívkovitý prst Mallet toe- dig. hamatus N DH 3 noha Dig. superductus N dig super Aseptic necrosis of bones m. Köhler I. m. Köhler II. m. Haglund- Sever Osteochondropathy of sesamoid bones AVN- Kohler 2 AVN Bursitis and entesopathies Achillodynia Calcanear spur Haglund exostosis Os tibiale externum Entezopatie - noha Noha - ostruha Calcanear spur noha- akcesorní kůstky os trigonum noha- os tibiale ext Obr. 97 Os tibiale externum Obr. 98 Os trigonum Accesory bones Fibromatosis pedis Plantar fibromatosis Morton Morton neuralgia Unquis incarnatus Unquis incarnatus Noha- diabetická Diabetic foot 7-15 % diabetics Diabetic neuropaty Ischemic disease of lower Extremity Diabetic microangiopaty Obr. 100 Noha- diabetická Diabetic foot Charcot neuropatic joints noha Diabetic foot Ulcers Necrosis Noha- diabetická Management Team work Regular f/up Insulin -therapy Desinfection Proteolytic agents Antibiotics Vasodilatancia, vit E Angioplasty Bypass Hyperbaric chamber Immobilisation Arthrodesis Amputation (15 %) Other causes of pain in the foot Neurogenic: sciatica, spinal stenosis Vascular: varixes chronic venous insuficiency, ischemic vessel disease Stress fractures Synovitis of MTPh joints Sesamoid bone problems Tumors Inflammations: pyogenic, R.A., psoriatic, gout Tenosynovitis Neurogenic artropathies Noha- podagra N arthritis