· tibialis posterior tendon rupture (most common)
· Lisfranc joint degeneration
· arthritis of hindfoot
· Charcot joint
· see separate section
· post injury
· degenerative arthritis develops after fracture dislocation
· acute injury often missed
· adequate acute treatment may not prevent occurrence
· idiopathic
· not related to trauma
· degenerative changes invariably involve 2nd MT-2nd cuneiform jt
· may involve 1st and 3rd jts
· rarely involves 4th and 5th jts
· rigid support
· try moulded arch support or UCLB initially
· may need double upright caliper with inside T strap
· realignment of Lisfranc joint
· with arthrodesis
· due to involvement of
· ankle joint
· subtalar joint
· midtarsal joint
· valgus tilt of talus leads to pronation of talus and calcaneus
· flatfoot deformity corrected when ankle joint realigned
· usually follows injury to talus or calcaneus
· typically following following calcaneal fracture
· for flexible deformity or mild symptoms
· initially use moulded arch support or UCLB insert
· may require rigid orthosis
· double upright with medial T strap
· for rigid deformity
· arthrodesis of affected joint
· usually associated with diabetes
· may be marked collapse
· develop bony prominence on medial sole
· may cause ulceration
· treated with
· casting and NWB during active collapse
· bracing to minimise wt bearing on foot