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 •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- formule •Types of the foot •a quadratic •b greece •c egyptian •Obr. 50 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