(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The subject of this case is a 12-year-old elementary school student who accidentally sprained his left foot during activity, causing pain in the medial aspect of the left foot. A weight-bearing orthopantomogram of the foot was taken, suggesting a flat foot deformity with a pars plana. The diagnosis was congenital pars plana and secondary flatfoot. After the surgical orthopedic treatment, the longitudinal arch of the foot was restored and the wound was free of redness, swelling and exudation, and the recovery was good.
Basic information】Female, 12 years old
Disease Type】Congenital pars plana, secondary flatfoot
Hospital】Shanxi Provincial People’s Hospital
Date of Consultation】May 2021
Treatment plan】Surgical treatment (left posterior tibial tendon stop displacement + left heel bone osteotomy internal displacement + paravalvulotomy)
Treatment Period】8 days of inpatient treatment and 1 month of outpatient follow-up
Results】Recovery of longitudinal arch of the foot, good wound recovery, and significant pain reduction
I. Initial consultation
The patient was accompanied by his family to the hospital and walked with a limp due to pain in his left foot. He reported that he sprained his left foot during an activity six months ago, and his family thought that it was common to sprain the foot, so they mainly rested. After a brief communication, the patient was allowed to take off his shoes and stand on the mat, and visual inspection revealed that the feet were not quite the same as normal, the arch was lower than normal, and a bony bulge could be palpated on the medial side of the left foot. According to the patient’s medical history, physical examination and imaging examination, the diagnosis was congenital pars plana and secondary flatfoot.
II. Treatment history
After the diagnosis of the patient’s condition was clear, the patient and his accompanying family members were advised to be hospitalized for surgical treatment. At first, the patient and his family had some fears, but after I briefly introduced the patient’s knowledge about clubfoot and the necessity of surgery, the patient and his family slowly put down their worries and agreed to be hospitalized for surgical treatment. After completing the preoperative examination, the patient was scheduled for surgery on the third day, and the surgery was performed by transposition of the left posterior tibial tendon stop + internal transposition of the left heel osteotomy + subtalar resection. Postoperative review of the weight-bearing frontal and lateral foot and heel axial radiographs showed that the longitudinal arch of the foot was improved compared with before.
III. Treatment results
The patient’s surgery was successful, and the longitudinal arch of the foot was improved on review of the weight-bearing ortholateral view and axial view of the heel bone. On the 7th day after surgery, the patient’s wound was free of redness, swelling and exudation, and the wound healed well and the pain was significantly reduced. Before discharge, the patient was especially advised to keep an eye on the wound for redness, swelling, exudation, and blackening of the skin edge to determine whether there are signs of infection and skin edge necrosis, and if there is any abnormality, the patient should be reviewed immediately.
IV. Precautions
The little patient in this case successfully completed the surgery, and the arch of the foot was restored, which greatly improved the quality of life. He no longer needs to worry about the foot pain caused by walking too far away, and he is truly happy for him. Although recuperating at home, it is also necessary to pay attention to the local changes of the wound, change the medicine once in 2-3 days after discharge, and remove the stitches 3 weeks after surgery, it is recommended that the stitches be removed in 2 times, the first time intermittently remove half of the stitches, and the second time remove the remaining stitches. After 1 year of good recovery, the endoprosthesis can be removed at an optional date. In daily life, it is recommended to choose shoes with good arch support and stable and comfortable upper. After excessive exercise or walking, it is recommended to rest and relax properly, which can be assisted by using a foot massager. After surgery, foot and ankle pump can be used to help exercise the stability of the foot and ankle.
V. Personal insight
Flatfoot is not easy to be detected, often because of frequent activities after the foot discomfort, long-term can not be relieved and seek medical attention, such as the patient in this case, the soporific is after treatment to relieve the symptoms. It is recommended that patients with flatfoot actively intervene in formal treatment, and after imaging, if the longitudinal arch of the foot is less reduced, they can first wear orthopedic shoes for treatment and regular outpatient review.