Durham Flatfoot Plasty

Durham flat foot angioplasty is used for surgical treatment of loose flat feet. The loose flat foot, also known as the deformable flat foot or the flexible flat foot, is characterized by the disappearance of the medial longitudinal arch when the weight is loaded, and the longitudinal arch can return to the normal position when the weight is not loaded. In addition, there may be a talus protruding to the medial and temporal sides of the foot, the forefoot in the plane and achilles tendon plane abduction, heel valgus and Achilles tendon shortening. Treatment should be based on non-surgical treatments, such as using an arch pad or wearing orthopedic shoes to strengthen the muscles of the foot. Only a few loose flat feet have to be treated surgically. For the relaxation of flat feet in children over 10 years old, the pain symptoms are severe, dysfunction, and those who are not treated by non-surgical treatment should consider surgery. Surgery should be aimed at relieving pain that can cause dysfunction, and can only be used after all kinds of non-surgical treatments are ineffective. It should not be operated for cosmetic purposes only. There are many surgical methods, which should be based on the condition of the sick child, and strictly control the indications for surgery. This section only describes the five more commonly used procedures. For a few loose flat feet of the age of 12 years and older, due to the secondary changes of bones and joints and soft tissue loss of their deformability, the formation of fixed deformity or the main joints of the feet, ligaments are extensively severely loose with obvious symptoms, should be Stable surgery of the hind foot, namely the three joint fusion. The procedure includes the anterior iliac muscle and the bone-periosteal flap and the fusion scaphoid-first wedge-shaped joint. Treatment of diseases: flat feet Indication Durham flat foot angioplasty is suitable for children with children over 10 years old with loose flat feet. The symptoms are severe and are not treated by non-surgical treatment. The lateral radiograph of the foot when the weight is loaded shows that the medial longitudinal arch collapses in the scapular joint. Contraindications Stiff flat feet or fixed foot valgus deformity, severe joint relaxation of the main joints of the feet and obvious deformity of the tibia. Preoperative preparation It includes lateral X-rays of the foot in weight-bearing and non-weight-bearing conditions, skin preparation, orthopedic instruments such as bone knives, screws and hand drills. Surgical procedure Incision The same incision as the Miller procedure was used. 2. Posterior tendon release and bone-periosteal valve detachment The posterior tibial tendon is identified by the aforementioned incision and traced to the scaphoid. After loosening the tendon, the tendon is sharply cut at the attachment of the scaphoid bone on the dorsal, temporal and deep sides (outer side), and the tendon stump is reflexed 2 to 3 cm proximally, placed in isotonic saline gauze. . A knife is used to delineate the edge of the distal ligament-bone-periosteal flap, which begins proximally from the scaphoid joint and distally to the base of the first metatarsal. The tissue flap was freed with a thin layer of cortical-cancellous bone of the scaphoid and the first wedge-shaped bone with a thin bone knife of 1.3 to 1.6 cm width, and the tissue flap was also placed in isotonic saline gauze. At the proximal end of the medial ligament severing zone, the incision is extended proximally, revealing the load-distortion, but not cutting the long flexor tendon. 3. Foot scaphoid - 1st wedge-shaped bone arthrodesis A thin bone knife of 1.0 to 1.3 cm width was used again to cut a wedge-shaped bone piece with the base portion located on the inner side and the temporal side from the scaphoid-first wedge-shaped joint surface. Face the cancellous bones on both sides and fix them with a Kirschner wire or a small cancellous bone screw. The forefoot is rotated, adducted, and planted at this joint to help correct the deformity. If the wedge-shaped osteotomy area is difficult to close, it is feasible to cut the bone from the middle of the iliac crest to the outer edge of the foot. After the osteotomy, the defect area of the wedge-shaped osteotomy can be completely closed, and the forefoot can also be placed in an ideal position. 4. The advancement of the bone-periosteal flap and the posterior tibial muscle Use a curette or rongeur to remove the lumbar side of the scaphoid side of the foot to prepare for reattaching the posterior tibial tendon to the outside of the cut. Two holes are drilled from the dorsal side to the sac on the scaphoid, passing through the waist. The 0-0 non-absorbent suture was woven back and forth through the posterior tendon, and the ends of the two sutures were delivered from the temporal side of the two small bone holes in the scaphoid to the dorsal side, and set aside. Temporarily not fixed tendon. Identify the load-carrying protrusion, use a small towel pliers or drill bit to drill two holes in the non-joint part of the load-bearing protrusion. Similarly, use the 0-0 non-absorption line to pass back and forth through the free end of the bone-periosteal flap. The side passes through the bone hole, and the suture is tied down in the forefoot flexion and supination state, and the tissue flap is fixed on the load-bearing protrusion. Then, the posterior tibial tendon is pulled to the prepared bed at the temporal side of the scaphoid, which is tightened and knotted on the dorsal side of the foot. The free edge of the bone-periosteal flap was sutured to the ligament, periosteal tissue and posterior tibial tendon adjacent to the dorsal and temporal sides. 5. Guanchuang Remove the tourniquet, stop bleeding, suture the incision, and aseptically dress.