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Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Radiographic templating

2

Execute a surgical walkthrough

  • describe steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • casting materials
  • #6900 beaver plade

2

Room setup and equipment

  • OR table

3

Patient positioning

  • supine
G

Cavus Deformity Correction

1

Supinate the pronated foot

2

Elevate the first metatarsal

3

Place a well molded plaster cast with the forefoot supinated and a mold under the first metatarsal

  • this will maintain all the metatarsal heads in a row
H

Forefoot Adductus and Hindroot Varus Correction

1

Manipulate the forefoot

  • abduct the forefoot against counterpressure on the head of the talus
  • make sure the counterpressure is not on the fibula or the calcaneocuboid joint
  • this will correct the metatarsus adductus by reduction of the metatarsals and the navicular on the head of the talus and the cuboid on the calcaneus
  • with further casting the calcaneus will begin to evert and abduct under the talus
  • the hindfoot will then begin to convert from varus to neutral or valgus
  • it is critical to perform abduction with the foot in with the forefoot in supination and the foot in equinus so that the calcaneus can evert and abduct underneath the talus

2

Perform serial maniulations and casting

  • perform weekly manipulations and castings with the forefoot in supination and with the foot in equinus until full correction of forefoot adduction and hindfoot varus is obtained
I

Equinus Correction

1

Prepare for the tenotomy

  • prepare the area with Betadine prep
  • if performing in the office, place topical anesthetic to the area of the tenotomy 45 minutes before the procedure

2

Position the extremity

  • have an assistant hold the knee
  • position the foot to avoid excessive dorsiflexion
  • be aware of the location of the medial neurovascular bundle and remember the elevated calcaneal pitch

3

Perform a heel cord tenotomy

  • perform the tenotomy about 1.5 cm above the palpable tuberosity of the calcaneus
  • insert a #6900 beaver blade or # 11 blade medial to the tendon edge
  • rotate the blade laterally so that is lies partially anterior to the Achilles tendon
  • use a the contralateral finger to push the Achilles tendon against the blade to complete the tenotomy

4

Confirm that complete tenotomy has been performed

  • complete tenotomy is confirmed when there is an audible pop and there is an increase in dorsiflexion of approximately 20 degrees
J

Casting of the Tenotomy

1

Prepare the surgical site for casting

2

Place the cast

  • place a well molded plaster cast over a sterile cotton roll over the tenotomy site
  • apply the cast with maximum dorsiflexion and abduction of the foot
  • place mold over talar head for counter pressure
Postoperative Patient Care
 

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