Modified Hoke-Miller procedure

Modified Hoke-Miller surgery for surgical treatment of loose flat feet. The loose flat foot, also known as the deformable flat foot or the flexible flat foot, is characterized by the disappearance of the medial longitudinal arch when the weight is loaded, and the longitudinal arch can return to the normal position when the weight is not loaded. In addition, there may be a talus protruding to the medial and temporal sides of the foot, the forefoot in the plane and achilles tendon plane abduction, heel valgus and Achilles tendon shortening. Treatment should be based on non-surgical treatments, such as using an arch pad or wearing orthopedic shoes to strengthen the muscles of the foot. Only a few loose flat feet have to be treated surgically. For the relaxation of flat feet in children over 10 years old, the pain symptoms are severe, dysfunction, and those who are not treated by non-surgical treatment should consider surgery. Surgery should be aimed at relieving pain that can cause dysfunction, and can only be used after all kinds of non-surgical treatments are ineffective. It should not be operated for cosmetic purposes only. There are many surgical methods, which should be based on the condition of the sick child, and strictly control the indications for surgery. This section only describes the five more commonly used procedures. For a few loose flat feet of the age of 12 years and older, due to the secondary changes of bones and joints and soft tissue loss of their deformability, the formation of fixed deformity or the main joints of the feet, ligaments are extensively severely loose with obvious symptoms, should be Stable surgery of the hind foot, namely the three joint fusion. The procedure includes a scaphoid fusion, a first wedge-shaped wedge-shaped open osteotomy with a base on the dorsal side, and a bone-periosteal flap distal advancement including a sacral heel ligament to achieve elevation and depression. The medial column of the humerus, the shortened foot, the medial longitudinal arch, the supination of the tibialis anterior muscle, and the purpose of correcting the loose flat foot. Treatment of diseases: flat feet Indication The modified Hoke-Miller procedure is suitable for the relaxation of flat feet in adolescents over 10 years old. The symptoms are severe and are not treated by non-surgical treatment. The lateral radiographs under weight bearing show the collapse of the boat or the wedge joint. Contraindications Stiff flat feet or fixed foot valgus deformity, severe joint relaxation of the main joints of the feet and obvious deformity of the tibia. Preoperative preparation It includes lateral X-rays of the foot in weight-bearing and non-weight-bearing conditions, skin preparation, orthopedic instruments such as bone knives, screws and hand drills. Surgical procedure Incision and bone-periosteal flap A longitudinal arcuate incision is made along the medial side of the foot to the dorsal side, starting from about 2 cm below the medial malleolus, extending distally through the scaphoid and the first cuneiform bone, ending at the base of the first metatarsal. The patellofemoral ligament, the tibialis anterior tendon and the posterior tibial tendon are exposed, and the tibialis anterior tendon is detached proximally from its stopping point and lifted. Bone-periosteal flap: On the proximal side of the anterior tibial tendon, a sharp-edged bone knife is used to cut a base with a sacral heel ligament, posterior tibial tendon, periosteum, and scaphoid and first wedge-shaped thin bone. The bone-periosteal flap of the sheet has a width of about 1.3 cm at the distal end and about 1.9 cm at the base. After the bone-periosteal flap is turned upside down and turned to the proximal side, the distance from the boat, the boat wedge and the first wedge joint are revealed. The periosteum and ligament on the scaphoid and the first wedge-shaped bone were slightly peeled off to the dorsal side and the temporal side, respectively, to facilitate suturing. 2. Scaphoid-first wedge-shaped bone joint fusion and the first wedge-shaped open wedge osteotomy The proximal bone-periosteal flap is placed on the posterior side, and the articular surface of the scaphoid-first wedge-shaped bone joint is removed, and only the articular cartilage is removed by thin-layer cutting. Osteotomy was initiated at the center of the dorsal side of the first wedge-shaped bone with a 1 cm wide osteotome. The direction of osteotomy should be 10° inward, 10° proximally, and avoiding cortical bone that penetrates the temporal side. The scaphoid is removed and used as a graft. The transplanted bone is inserted into the dorsal aspect of the first wedge bone (for example, the scaphoid is not large enough, and the autogenous iliac bone or the bone base bone can be used). The scaphoid-first wedge-shaped bone joint was inserted with a Kirschner wire or a cancellous bone screw together with a bone block inserted into the first wedge-shaped bone for internal fixation. 3. Bone-periosteal flap and sacral ligament and posterior tendon of tendon The proximal bone-periosteal flap with the base portion is advanced distally to the distal temporal side of the tibialis anterior tendon. The tissue flap was sutured to the adjacent ligament with a 0-0 non-absorbable suture, and the posterior tibial tendon was pulled toward the temporal side, and the talus was also incorporated into the scaphoid fossa. The intermittent suture method was used to sew the patellofemoral ligament and the posterior tibial muscle at the temporal side of the temporal and periosteal flaps. Occasionally it may be necessary to perform an Achilles tendon extension. complication After the modified Hoke-Miller operation, the long leg tube gypsum was fixed, the knee joint flexed about 30°, the ankle joint was 90°, the forefoot was drooping, the heel was slightly inverted, and the arch was properly shaped. 4 to 6 weeks after surgery, can be changed to short leg tubular walking plaster. Twelve weeks after surgery, the X-ray photograph showed that the fixed joint bone fusion was changed to wear hard-soled shoes with an arch pad for more than half a year. Postoperative diet 1. Give high protein, high vitamin and cellulose-rich digestible diet. 2, do not eat spicy spicy food.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.