1. Foot and ankle issues in collagen vascular disorders
Patrick Agnew, DPM, FACFAS, FACFAP, Virginia Beach, VA
Director, Eastern Virginia Medical School PMS 24
Past President ACFAPediatrics
Captain, (SCWO), MSC, USNR-R

2. Previous research
Common foot problems identified by survey, Seattle, WA
Xrays taken at Detroit Children’s Hospital evaluated
Footmax scans collected, Philadelphia, PA

3. Collagen vascular disorders
Ehlers-Danlos Syndrome
Marfans Syndrome
Osteogenesis imperfecta
Etc….

4. Special considerations
Soft tissue handling
Vascular fragility?
Bone fragility?
Over pronation or sagging
Ankle may still be tight!

5. Common foot problems Hypermobility
“Flat feet” with or without over pronation

6. Common foot problems Uncommon manifistations
“Bunions” with joint fluid leak (ganglion cyst)

7. Principles of podiatric intervention
Align and maintain functional anatomy
Avoid skin injury
Don’t rely on ligaments
Select and time invasive intervention carefully

8. Align and maintain functional anatomy
Foot orthoses-> controversial
Arthrodesis -> anecdotally mediocre results
Osteotomies -> more reliable, much experience
Arthroresis -> controversial but promising
Ligament replacement -> new devices

9. Sub talar arthroresis

10. Subtalar Arthroresis
History/variations
goals
Disadvantages
Advantages

11. HISTORY bone procedures Chambers 1946: bone block
Subotnick 1974 silastic carved plug
Current:
Metal implants
Absorbable implants

12. HISTORY
Polymers
Metals
absorbable

13. Goals of STA Relief of pain Improved joint alignment and function
Interruption of patho-mechanical progression
“correction” of “deformity”???

14. STATE OF THE ART

15. State of the art

16. Size matters! CT measurements of sinus tarsus
Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable sub talar arthroeresis, JFAS, 2007

17. Metatarsus Adductus

18. Diagnosis
Infancy
Toddler hood
Childhood
Adultery ;)

19. Multiplanar deformities

20. Prognosis No reliable method
Uncompensated: styloid process, HAV?, ankle injuries, lateral knee?, claw toes…
Compensated: complex over pronation, HAV?, hammertoes

21. Management Observation(?) “stretching”(?) Casting Splinting Shoes(?)
Surgery

22. Good solutions for bad ligaments
Strong: absorbable vs non absorbable
Minimally invasive (small incisions)
May obviate some bone surgeries
May permit weight bearing immediately

23. External fixation
Mini rails
May obviate second surgeries, may result in less bone surgeries

24. Please pray for our troops

25. We Build, We Fight, For Peace with Freedom.
US NAVY SEA BEES