Copy of Peroneal spastic flat foot

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Peroneal spastic flat foot:

Peroneal spastic flat foot Presented by Dr. Abdullah-Al-Mamun MS ( ortho )-Thesis part student Department of orthopaedics BSMMU

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Peroneal spastic flat foot is characterized by a stiff foot, usually present from early life, often with some degree of valgus deformity, but frequently unrecognized until pain and spasm of the peroneal muscles develop, usually in the second decade.

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The essential cause of this condition is one or other of several different intertarsal fusion which limit and distort the movement of tarsal joints. These congenital fusions, which may be complete or incomplete, probably represent failure of joint cavitations or of mesenchymal differentiation.

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The more common intertarsal fusions are a medial talocalcaneal bridge or a calcaneonavicular bar –The most common cause of rigid flat foot. The anomaly is inherited as an autosomal dominant condition.

Other causes of PSFF:

Other causes of PSFF Rheumatoid arthritis Osteochondral fracture Infection of subtalar joint (TB, Mycotic, Pyogenic) Neoplasm( Osteoid osteoma, osteochondroma) fibrosarcoma (can be differentiated by history)

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The coalition ,while still fibrous and cartilaginous, allow some degree of movement and are there fore asymptomatic in early childhood. They ossify at different ages and as movement becomes restricted, symptoms appear.

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Clinical assessment: Older children and teenagers with a painful rigid flat foot in which the peroneal and extensor tendons are in spasm. Pain may be due to abnormal tarsal stress or even fracture of an ossified bone

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Diagnosis is confirm by X-ray or CT scan but other cause of rigid flat should exclude. On lateral view – Breaking of the head of the talus suggest the presence of tarsal coalition. Calcaneonavicular bars, if ossified, can be seen in oblique views of the foot.

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Treatment Conservative : Manipulation under anesthesia, a below knee walking plaster, an outside iron and inside T- strap or by combination of this method. Operative :Indication persistent pain ,muscles spasm and deformity not relieved by conservative Rx

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Option: Operative removal of calcaneonavicular bar Triple arthodesis Osteotomy of the os calcis by correcting the alignment and over coming the oblique strain.

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Thank you

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