Review Question - QID 212188

One of the most common complications during retrograde hindfoot nailing is damage to the lateral plantar nerve, leading to numbness over the lateral, plantar midfoot extending distally.

Hindfoot nailing is appropriate in cases of rigid hindfoot valgus, ankle valgus, and tibiotalar arthritis. The starting point for hindfoot nailing is over mid-aspect of the plantar heel in order to be centered in the talus and tibia. This corresponds closely with the path of the lateral plantar nerve as it branches medially from the tibial nerve. If the nerve is irritated or transected it can cause numbness or parasthesias in the lateral aspect of the plantar mid- and forefoot. This can be avoided with careful soft tissue dissection and retraction down to bone when placing the initial guidewire and during nail insertion.

Deland provides a review of adult-acquired flatfoot deformity, noting that it was initially described as PTTI, but also encompasses other deformities. Early diagnosis and appropriate management is helpful in treating symptoms and progression. If surgery is necessary, the goal is to improve alignment of the foot, while maintaining as much flexibility as possible.

Haddad et al. provides an overview of the management and treatment of acquired flatfoot deformity. They note that much of the controversy revolves around stage II deformities, as surgical options are more broad with the foot remaining flexible. They go on to describe, at length, the different surgical options and tips/tricks associated with each technique.

Illustration A demonstrates the path of the lateral plantar nerve after it splits from the tibial nerve. Illustration B demonstrates the sensory innervation of the foot.

Incorrect Answers:
Answer 2: Medial plantar nerve controls sensation to the medial plantar mid- and fore-foot.
Answer 3: Sural nerve controls sensation over the the lateral hindfoot.
Answer 4: Saphenous nerve controls sensation over the medial hindfoot.
Answer 5: Medial calcaneal nerve controls sensation over the plantar hindfoot.