Lowman procedure and Young's modified Lowman procedure

Indication Lowman surgery and Young's modified Lowman procedure are suitable for adolescents with a deformable flat foot over 10 years of age. The medial longitudinal arch collapse is located in the scaphoid joint. Contraindications Stiff flat foot or fixed foot valgus deformity; severe major joint relaxation of the foot, and severe deformity of the humerus. 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 1.Lowman procedure (Lowman Procedure) (1) Make a longitudinal skin incision on the medial edge of the Achilles tendon, reveal the Achilles tendon, and cut a purine strip with a width of about 0.6 cm and a length of about 12 cm from the medial edge to retain the attachment point on the calcaneus. If the Achilles tendon is shortened, the Z-shaped extension is made so that the foot can extend 5°. (2) Make a longitudinal arcuate incision slightly to the dorsal side of the foot, starting from below the medial malleolus. The posterior aspect of the scaphoid continues to extend to the distal temporal side to reach the base of the first metatarsal. The deep fascia was dissected to reveal the tibialis anterior tendon, the posterior tibial tendon, and the lateral heel ligament. (3) Cut the distance between the boat ligament and the joint capsule along the joint line of the boat, and expose the inner side of the joint and the scaphoid. In the scapular joint, the wedge-shaped osteotomy of the base to the medial and temporal sides, if the talus neck is too long, should remove enough bone, so that the forefoot abduction deformity and the medial longitudinal arch collapse can be completely corrected. (4) The distal tibialis tendon is released distally to its stopping point, and then the tendon is moved to the outside of the talus and scaphoid space. (5) overlapping sutures from the ligament of the boat. The sacral sac was pulled through the ankle into the medial incision and the distal end was sutured to the anterior tibial tendon on the side of the scaphoid. Suture the incision. 2.Young's Modified Lowman Procedure (Modified Lowman Procedure) If the Achilles tendon is shortened, first do Achilles tendon extension. (1) Make a longitudinal arcuate skin incision on the medial side to expose and separate the tibialis anterior tendon and the posterior tibial tendon. Cut the posterior tibial tendon at its stop. (2) Approximately 1.2 cm from the lateral side of the scaphoid nodule on the dorsal side of the scaphoid, a bone hole with a diameter of about 0.5 cm was drilled to the iliac crest, and the dorsal hole of the bone hole was expanded into an oval shape. On the lateral side of the first wedge bone and the scaphoid, a bone groove is cut between the anterior tibial tendon and the ostium hole. Then, a bone slit of about 0.5 cm in width is cut between the inner corner of the scaphoid and the bone hole. (3) Incision of the distal tendon sheath of the anterior tibial tendon until its stop point, the tendon is moved into the bone hole of the scaphoid, and the bone suture is filled with broken bone. (4) suture the posterior tendon. Sew the incision in layers. complication The main complication was that the deformity was not corrected or that there was no bone fusion to the joint.