Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia...
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Transcript of Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia...
![Page 1: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/1.jpg)
Foot and ankle issues in Foot and ankle issues in collagen vascular disorderscollagen vascular disorders
• Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VAVA
• Director, Eastern Virginia Medical School PMS 24Director, Eastern Virginia Medical School PMS 24
• Past President ACFAPediatricsPast President ACFAPediatrics
• Captain, (SCWO), MSC, USNR-RCaptain, (SCWO), MSC, USNR-R
![Page 2: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/2.jpg)
Previous researchPrevious research
• Common foot problems identified by survey, Common foot problems identified by survey, Seattle, WA Seattle, WA
• Xrays taken at Detroit Children’s Hospital Xrays taken at Detroit Children’s Hospital evaluatedevaluated
• Footmax scans collected, Philadelphia, PAFootmax scans collected, Philadelphia, PA
![Page 3: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/3.jpg)
Collagen vascular disordersCollagen vascular disorders
• Ehlers-Danlos SyndromeEhlers-Danlos Syndrome
• Marfans SyndromeMarfans Syndrome
• Osteogenesis imperfectaOsteogenesis imperfecta
• Etc….Etc….
![Page 4: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/4.jpg)
Special considerationsSpecial considerations
• Soft tissue handlingSoft tissue handling
• Vascular fragility?Vascular fragility?
• Bone fragility?Bone fragility?
• Over pronation or saggingOver pronation or sagging
• Ankle may still be tight! Ankle may still be tight!
![Page 5: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/5.jpg)
Common foot problemsCommon foot problems
• HypermobilityHypermobility
• ““Flat feet” with or without over pronationFlat feet” with or without over pronation
![Page 6: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/6.jpg)
Common foot problemsCommon foot problems
• Uncommon Uncommon manifistationsmanifistations
• ““Bunions” with Bunions” with joint fluid leak joint fluid leak (ganglion cyst)(ganglion cyst)
![Page 7: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/7.jpg)
Principles of podiatric Principles of podiatric interventionintervention
• Align and maintain functional anatomyAlign and maintain functional anatomy
• Avoid skin injuryAvoid skin injury
• Don’t rely on ligamentsDon’t rely on ligaments
• Select and time invasive intervention carefullySelect and time invasive intervention carefully
![Page 8: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/8.jpg)
Align and maintain functional Align and maintain functional anatomyanatomy
• Foot orthoses-> controversialFoot orthoses-> controversial• Arthrodesis -> anecdotally mediocre Arthrodesis -> anecdotally mediocre
resultsresults• Osteotomies -> more reliable, much Osteotomies -> more reliable, much
experienceexperience• Arthroresis -> controversial but promisingArthroresis -> controversial but promising• Ligament replacement -> new devicesLigament replacement -> new devices
![Page 9: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/9.jpg)
Sub talar arthroresisSub talar arthroresis
![Page 10: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/10.jpg)
Subtalar ArthroresisSubtalar Arthroresis
• History/variationsHistory/variations
• goalsgoals
• DisadvantagesDisadvantages
• AdvantagesAdvantages
![Page 11: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/11.jpg)
HISTORYHISTORY
• bone proceduresbone procedures
• Chambers 1946: bone blockChambers 1946: bone block
• Subotnick 1974 silastic carved plugSubotnick 1974 silastic carved plug
• Current:Current:
• Metal implantsMetal implants
• Absorbable implantsAbsorbable implants
![Page 12: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/12.jpg)
HISTORYHISTORY
• PolymersPolymers
• MetalsMetals
• absorbableabsorbable
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Goals of STAGoals of STA
• Relief of painRelief of pain
• Improved joint Improved joint alignment and alignment and functionfunction
• Interruption of Interruption of patho-mechanical patho-mechanical progressionprogression
• ““correction” of correction” of “deformity”???“deformity”???
![Page 14: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/14.jpg)
STATE OF THE ARTSTATE OF THE ART
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State of the artState of the art
![Page 16: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/16.jpg)
Size matters!Size matters!
• CT measurements of sinus tarsus CT measurements of sinus tarsus
• Preliminary radiographic findings and sizing Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable sub implications on patients undergoing bioabsorbable sub talar arthroeresis, JFAS, 2007talar arthroeresis, JFAS, 2007
![Page 17: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/17.jpg)
Metatarsus AdductusMetatarsus Adductus
![Page 18: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/18.jpg)
DiagnosisDiagnosis• InfancyInfancy
•Toddler Toddler hoodhood
•ChildhooChildhoodd
•Adultery Adultery ;);)
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Multiplanar deformitiesMultiplanar deformities
![Page 20: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/20.jpg)
PrognosisPrognosis• No reliable methodNo reliable method
• Uncompensated: Uncompensated: styloid process, styloid process, HAV?, ankle injuries, HAV?, ankle injuries, lateral knee?, claw lateral knee?, claw toes…toes…
• Compensated: Compensated: complex over complex over pronation, HAV?, pronation, HAV?, hammertoeshammertoes
![Page 21: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/21.jpg)
ManagementManagement
• Observation(?)Observation(?)
• ““stretching”(?)stretching”(?)
• CastingCasting
• SplintingSplinting
• Shoes(?)Shoes(?)
• SurgerySurgery
![Page 22: Foot and ankle issues in collagen vascular disorders Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA Patrick Agnew, DPM, FACFAS, FACFAP, Virginia.](https://reader035.fdocuments.in/reader035/viewer/2022062518/56649cf95503460f949cb348/html5/thumbnails/22.jpg)
Good solutions for bad Good solutions for bad ligamentsligaments
• Strong: absorbable vs non absorbableStrong: absorbable vs non absorbable
• Minimally invasive (small incisions)Minimally invasive (small incisions)
• May obviate some bone surgeriesMay obviate some bone surgeries
• May permit weight bearing immediately May permit weight bearing immediately
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External fixationExternal fixation
•Mini railsMini rails
•May obviate May obviate second second surgeries, may surgeries, may result in less result in less bone surgeriesbone surgeries
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Please pray for our troopsPlease pray for our troops
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US NAVY SEA US NAVY SEA BEESBEES