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Foot and ankle issues in collagen vascular disorders

Foot and ankle issues in collagen vascular disorders. Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Director, Eastern Virginia Medical School PMS 24 Past President ACFAPediatrics Captain, (SCWO), MSC, USNR-R. Previous research.

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Foot and ankle issues in collagen vascular disorders

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  1. Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Director, Eastern Virginia Medical School PMS 24 Past President ACFAPediatrics Captain, (SCWO), MSC, USNR-R

  2. Previous research • Common foot problems identified by survey, Seattle, WA • Xrays taken at Detroit Children’s Hospital evaluated • Footmax scans collected, Philadelphia, PA

  3. Collagen vascular disorders • Ehlers-Danlos Syndrome • Marfans Syndrome • Osteogenesis imperfecta • Etc….

  4. Special considerations Soft tissue handling Vascular fragility? Bone fragility? Over pronation or sagging Ankle may still be tight!

  5. Common foot problems Hypermobility “Flat feet” with or without over pronation

  6. Common foot problems • Uncommon manifistations • “Bunions” with joint fluid leak (ganglion cyst)

  7. Principles of podiatric intervention Align and maintain functional anatomy Avoid skin injury Don’t rely on ligaments Select and time invasive intervention carefully

  8. Align and maintain functional anatomy Foot orthoses-> controversial Arthrodesis -> anecdotally mediocre results Osteotomies -> more reliable, much experience Arthroresis -> controversial but promising Ligament replacement -> new devices

  9. Sub talar arthroresis

  10. Subtalar Arthroresis History/variations goals Disadvantages Advantages

  11. HISTORY bone procedures Chambers 1946: bone block Subotnick 1974 silastic carved plug Current: Metal implants Absorbable implants

  12. HISTORY Polymers Metals absorbable

  13. Goals of STA • Relief of pain • Improved joint alignment and function • Interruption of patho-mechanical progression • “correction” of “deformity”???

  14. STATE OF THE ART

  15. State of the art

  16. Size matters! CT measurements of sinus tarsus Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable sub talararthroeresis, JFAS, 2007

  17. Metatarsus Adductus

  18. Diagnosis Infancy Toddler hood Childhood Adultery ;)

  19. Multiplanar deformities

  20. Prognosis No reliable method Uncompensated: styloid process, HAV?, ankle injuries, lateral knee?, claw toes… Compensated: complex over pronation, HAV?, hammertoes

  21. Management • Observation(?) • “stretching”(?) • Casting • Splinting • Shoes(?) • Surgery

  22. Good solutions for bad ligaments Strong: absorbable vs non absorbable Minimally invasive (small incisions) May obviate some bone surgeries May permit weight bearing immediately

  23. External fixation • Mini rails • May obviate second surgeries, may result in less bone surgeries

  24. Please pray for our troops

  25. US NAVY SEA BEES We Build, We Fight, For Peace with Freedom.

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