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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses revision strategies for ankle and hindfoot treatment. Specific topics include supramalleolar osteotomy for the treatment of ankle osteoarthritis, tibiotalocalcaneal fusion using the retrograde intramedullary (IM) nail for complex hindfoot problems, strategies for surgical treatment of hindfoot valgus and varus deformities, as well as hindfoot malalignment with soft tissue concerns.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EFoot \u0026amp; Ankle Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBone Density \u0026amp; Structure Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EFoot \u0026amp; Ankle Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBone Density \u0026amp; Structure Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThis symposium featured 4 presentations covering revision strategies for ankle and hindfoot treatment. The first presentation reviewed evidence for the treatment of ankle osteoarthritis (OA) with supramalleolar osteotomy (SMOT). The second presentation focused on tibiotalocalcaneal (TTC) fusion using the retrograde intramedullary (IM) nail for complex hindfoot problems. Strategies for surgical treatment of hindfoot valgus and varus deformities were described in the third presentation. The final speaker presented case studies of unique hindfoot malalignment with soft tissue concerns, detailing clinical features, diagnosis, and treatment options.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESUBSTANTIAL PAIN RELIEF AND FUNCTIONAL IMPROVEMENT WITH SMOT\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAlexej Barg, MD, University Hospital of Basel, Basel, Switzerland, discussed the assessment and treatment options for ankle OA. Most patients with deformities of the distal tibia and fibula are younger and have posttraumatic OA. Concomitant problems often include instabilities, muscular dysbalances, and adjacent joint pathologies. Treatments include joint-preserving surgery (JPS) and joint replacement options. The option chosen depends on the complications and stage of ankle OA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAnkle OA causes an asymmetric joint load and asymmetric cartilage damage. The varus ankle is a complex problem with medialized pull of the heel cord, overload of the medial ankle and lateral ankle ligaments, and overstress of the peroneus brevis tendon. The valgus ankle results in lateralized pull of the heel cord, overload of the lateral ankle and medial ankle ligaments, and overstress of the syndesmotic ligaments.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe primary aims of realignment surgery are osseous and ligamental balancing and restoration of ankle and hindfoot biomechanics. Preoperative assessment includes conventional radiography and single-photon emission computed tomography.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDr Barg\u0027s group treated 42 patients with asymmetric ankle OA: 26 with valgus deformity and 16 with varus deformity [Barg A et al. \u003Cem\u003ETech Foot Ankle Surg\u003C\/em\u003E. 2013]. Anterior ankle arthroscopy was performed in 35 of these patients. Valgus deformities were treated with medial closing wedge osteotomy (OT) (n = 26). Varus deformities were treated with medial opening wedge OT (n = 11) or lateral closing wedge OT (n = 5). At a mean follow-up of 4.8 years, the medial distal tibial angle changed from 84.6\u00b0 \u00b1 7.0\u00b0 to 91.2\u00b0 \u00b1 6.1\u00b0 in the varus group and from 93.5\u00b0 \u00b1 7.0\u00b0 to 88.8\u00b0 \u00b1 4.4\u00b0 in the valgus group. Visual Analog Scale (VAS) pain scores changed from 5.2 \u00b1 2.6 to 2.6 \u00b1 1.8. SMOT failed in 4 patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EPotential complications of ankle JPS can include injury of neurovascular tendons or structures, infection, wound healing problems, delayed union or nonunion, patient noncompliance with rehabilitation, and progression of OA in up to 25% of ankles.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ERealignment surgery with SMOT demonstrated substantial pain relief and functional improvement in clinical trials. Complications occurred in up to 25% of patients.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHIGH SUCCESS RATE WITH TTC FUSION USING THE IM NAIL IN COMPLEX HINDFOOT PROBLEMS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EComplex hindfoot problems that present a challenge for foot and ankle surgeons include Charcot arthropathy, failed total ankle arthroplasty (TAA), ankle and subtalar joint OA, and other deformities. The goal of treatment, regardless of cause, is to realign the foot. Jin Woo Lee, MD, PhD, Yonsei University College of Medicine, Seoul, Korea, discussed implant options for repair of these disorders.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EImplant choices include a cannulated screw, locking plate, external fixator (EF), and retrograde IM nail. Prof Lee prefers TTC fusion with the IM nail because it provides biomechanical stability compared with the EF [Fragomen AT et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 2008], the lag screws [Berend ME et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 1997], and the locking plate [O\u0027Neill PJ et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 2008]. The IM nail allows one-stage correction of deformity [Kane JM et al. \u003Cem\u003EJ Bone Joint Surg Br.\u003C\/em\u003E 2014] and results in a high union rate [Rammelt S et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 2013; M\u00fcckley T et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EOver 4 years, Prof Lee performed TTC fusion with the retrograde IM nail in 34 cases (32 patients). At a mean follow-up of 48 months, the overall union rate was 82% and the union duration was 7.6 months (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12084\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12084\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12084\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EUnion Status by Cause\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EImprovements in the VAS and American Orthopaedic Foot \u0026amp; Ankle Society scores were statistically significant (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .05; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) from preoperation to last follow-up.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Clinical and Patient Satisfaction Outcomes\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1427705456\u0022 data-figure-caption=\u0022Clinical and Patient Satisfaction Outcomes\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12081\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EClinical and Patient Satisfaction Outcomes\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAOFAS, American Orthopaedic Foot \u0026amp; Ankle Society; VAS, Visual Analog Scale.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from JW Lee, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EMajor complications occurred in 23.5% of cases. The failure rate was high in patients with uncontrolled diabetes (71%) vs all others (11%; \u003Cem\u003EP\u003C\/em\u003E = .004).\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003ETTC fusion with the retrograde IM nail offers a chance for successful salvage of complex hindfoot problems. However, there is an increased risk of failure in patients with uncontrolled DM.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESTRATEGIES FOR SURGICAL TREATMENT OF HINDFOOT VALGUS AND VARUS DEFORMITIES\u003C\/h2\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EEmilio Wagner, MD, Clinica Alemana, Santiago, Chile, discussed revision strategies for the correction of hindfoot misalignments. Evaluation of hindfoot deformities includes checking for underlying causes, identifying the origin, checking joint status and stiffness, and assessing midfoot compensation. The initial approach to treatment of valgus and varus deformities consists of conservative strategies, including weight and activity modification, orthotics, and physical therapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003E\n            \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E presents an algorithm for surgical treatment of hindfoot valgus deformities.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Hindfoot Reconstruction for Valgus Deformities\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1427705456\u0022 data-figure-caption=\u0022Hindfoot Reconstruction for Valgus Deformities\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12082\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EHindfoot Reconstruction for Valgus Deformities\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EFDL, flexor digitorum longus; SMO, supramalleolar osteotomy; TN, talonavicular.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced with permission from E Wagner, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-21\u0022\u003E\n            \u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E shows an algorithm for surgical treatment of hindfoot varus deformities.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Hindfoot Reconstruction for Varus Deformities\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1427705456\u0022 data-figure-caption=\u0022Hindfoot Reconstruction for Varus Deformities\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/27\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12083\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-22\u0022 class=\u0022first-child\u0022\u003EHindfoot Reconstruction for Varus Deformities\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EMTT, manual talar tilt; PB, peroneus brevis; PL, peroneus longus; PT, posterior tibial.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-6\u0022\u003EReproduced with permission from E Wagner, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12085\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12085\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12085\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-23\u0022 class=\u0022first-child\u0022\u003ECase Studies\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-26\u0022\u003EFor surgical treatment of hindfoot valgus, Prof Wagner recommended taking the alignment to a slight varus. Fusion may be necessary to achieve stability. For hindfoot varus, additional transfers or releases should be considered to regain ankle stability.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EUNIQUE TREATMENT FOR UNIQUE HINDFOOT MALALIGNMENT WITH SOFT TISSUE CONCERNS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-27\u0022\u003EMark Glazebrook, PhD, MD, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada, reviewed treatment strategies for unique cases of hindfoot malalignment with soft tissue concerns. Hindfoot deformity can be caused by progressive motor sensory conditions such as Charcot-Marie-Tooth disease, nonprogressive disorders such as cerebral palsy and poliomyelitis, and traumatic injuries. Evaluation includes taking a history to determine the source of pain, functional limitations, trauma history, and previous treatments. Physical examination of the standing gait and location of the deformity is important, as is neurologic examination, especially in progressive conditions. Examination also includes assessment of deformity flexibility or rigidity, Achilles length, leg-length discrepancy, and a Coleman block test. Other assessments include diagnostic imaging and electrodiagnostic tests.\u003C\/p\u003E\n         \u003Cp id=\u0022p-28\u0022\u003EAccording to Prof Glazebrook, a good clinical approach is needed when managing unique cases of hindfoot malalignment with soft tissue concerns; unique cases require unique treatment.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/34\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzorl1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzorl1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzorl1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}