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Suggest Treatment For Restricted Dorsiflexion In Ankle Joint Of A 11 Year Old
Question: This is 11 year old female child who was diagnosed to have decompensated Pes XXXXXXX abductus. she was given insoles but still She is complaining of pain especially after walking for long distance.
In the clinical examination, spine is straight. The lateral bending are physiologic, in the anterior bending, there is no thoracic or lumbar hump. No sign of scoliosis. The upper extremity is without any pathology. In the lower extremity, there is decompensated bilateral Pes Plano-valgus, which is completely instable to the lateral border. In standing position, not anymore lift up the Pes Plano-valgus. The insole can hardly resist and elevate the medial arch. All in all, the foot is quite XXXXXXX under non-weight bearing. The range of motion is the ankle joint is limited in dorsiflexion, so in knee extended position. There is no more dorsiflexion possibility. In the knee bent position, about 5 degree to 10 degree of dorsiflexion, which is still too low for a normal rollover of the foot.
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X- ray on both feet:
Bilateral Pes Plano-valgus changes are noted with loss of the planter arch on both sides.
Bilateral accessory navicular bones are seen.
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X-ray Both Lower Limbs:
The weight bearing axis on left side is passing by the lateral aspect of the medial compartment of the knee joint.
 The weight bearing axis on right side is passing by the intercondylar region of the knee joint.
No significant leg length discrepancy is seen.
Diagnosis
Bilateral decompensated Pes Plano-valgus abductus with contracture of the calf and positive Silfverskiold sign, right more than left.
Doctor recommended the following surgical procedure however my concern is that these procedures are for skew foot not for flat foot. Please advise on this
Achilles Tendon lengthening, XXXXXXX osteotomy with Tutobone bone graft for lengthening of the calcaneal bone, young tendon transfer of the tibialis anterior tendon should be done. Additionally, the Os Tibiale externum will be removed and the tibialis posterior tendon will be augmented.
In the clinical examination, spine is straight. The lateral bending are physiologic, in the anterior bending, there is no thoracic or lumbar hump. No sign of scoliosis. The upper extremity is without any pathology. In the lower extremity, there is decompensated bilateral Pes Plano-valgus, which is completely instable to the lateral border. In standing position, not anymore lift up the Pes Plano-valgus. The insole can hardly resist and elevate the medial arch. All in all, the foot is quite XXXXXXX under non-weight bearing. The range of motion is the ankle joint is limited in dorsiflexion, so in knee extended position. There is no more dorsiflexion possibility. In the knee bent position, about 5 degree to 10 degree of dorsiflexion, which is still too low for a normal rollover of the foot.
Â
X- ray on both feet:
Bilateral Pes Plano-valgus changes are noted with loss of the planter arch on both sides.
Bilateral accessory navicular bones are seen.
Â
X-ray Both Lower Limbs:
The weight bearing axis on left side is passing by the lateral aspect of the medial compartment of the knee joint.
 The weight bearing axis on right side is passing by the intercondylar region of the knee joint.
No significant leg length discrepancy is seen.
Diagnosis
Bilateral decompensated Pes Plano-valgus abductus with contracture of the calf and positive Silfverskiold sign, right more than left.
Doctor recommended the following surgical procedure however my concern is that these procedures are for skew foot not for flat foot. Please advise on this
Achilles Tendon lengthening, XXXXXXX osteotomy with Tutobone bone graft for lengthening of the calcaneal bone, young tendon transfer of the tibialis anterior tendon should be done. Additionally, the Os Tibiale externum will be removed and the tibialis posterior tendon will be augmented.
Brief Answer:
The surgery will increase flexibility around ankle.
Detailed Answer:
Hello,
Thanks for posting your query.
The surgical procedure that your surgeon has suggested will correct the restricted dorsiflexion. Once the mobility around the ankle increases she will be able to walk more comfortably. This surgery will not correct the flat foot but will increase the range of motion around the ankle.
The treatment that your surgeon has suggested is correct. Further physiotherapy will help in increasing the flexibility of the foot. She can continue using insoles. These will be more effective after the surgery.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
The surgery will increase flexibility around ankle.
Detailed Answer:
Hello,
Thanks for posting your query.
The surgical procedure that your surgeon has suggested will correct the restricted dorsiflexion. Once the mobility around the ankle increases she will be able to walk more comfortably. This surgery will not correct the flat foot but will increase the range of motion around the ankle.
The treatment that your surgeon has suggested is correct. Further physiotherapy will help in increasing the flexibility of the foot. She can continue using insoles. These will be more effective after the surgery.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. May I ask you what will be the treatment option for the flat foot or to correct the medial arch of the foot.
Brief Answer:
Calcaneal bone lengthening will help.
Detailed Answer:
Hello.
Thanks for writing again. XXXXXXX osteotomy and lengthening of calcaneal bone will help in prominence of the middle part of the foot. This will help in treatment of flat foot and the foot arch to rise. Rest of the deformity if any left can be corrected with orthotics.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Calcaneal bone lengthening will help.
Detailed Answer:
Hello.
Thanks for writing again. XXXXXXX osteotomy and lengthening of calcaneal bone will help in prominence of the middle part of the foot. This will help in treatment of flat foot and the foot arch to rise. Rest of the deformity if any left can be corrected with orthotics.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
you are absolutely right. In this case, treating doctor is requesting also for lengthening of tibialis anterior whic i understand that it is part of making medial arch but the augmentation of tibialis posterior which is also the part of medial arch but having little role. touching and Surgical intervention on tibialis posterior will be helpful in this patient?
Brief Answer:
Tibialis posterior augmentation can help in ankle movement.
Detailed Answer:
Augmentation of tibialis posterior will not help in flat foot but it may be needed to correct the restricted dorsiflexion of the ankle. This can only be decided after a physical examination and at the time of surgery by the treating surgeon. He can clinically evaluate augmentation of which tendon is needed. Without a physical examination it is not possible to guess which procedure will be more helpful.
Have faith on the treating surgeon. He will do the best for your daughter.
Regards.
Tibialis posterior augmentation can help in ankle movement.
Detailed Answer:
Augmentation of tibialis posterior will not help in flat foot but it may be needed to correct the restricted dorsiflexion of the ankle. This can only be decided after a physical examination and at the time of surgery by the treating surgeon. He can clinically evaluate augmentation of which tendon is needed. Without a physical examination it is not possible to guess which procedure will be more helpful.
Have faith on the treating surgeon. He will do the best for your daughter.
Regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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