surgical algorithm

Definition

Garden 1 / 2

Algorithm

ORIF

- ~ 15% displacement rate with non operative management

- increased risk of non union

- reduced hospital in patient stays

Options

Cannulated screws

DHS + derotation screw

3 cannulated screws

Surgical Algorithm

Stage 1 Tendonitis

Non-operative

Walking cast / NSAIDS

- 6/52

UCBL

- 3/12

- worn inside the shoe

- ends under malleoli

- controls the heel (which must be flexible)

- supports the arch

Operative / Synovectomy and debridement

(+/- FDL transfer and calcaneal osteotomy +/- T Achilles lengthening)

Non-Operative

Education regarding shoe wear

- extra wide / large toe box

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

Toe spacers

Analgesia

Operative

Indications

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Anatomy

Lateral compartment of leg

- run through retromalleolar groove

- pass superior and inferior to peroneal tubercle

- covered by inferior peroneal retinaculum

Peroneus longus

- origin lateral condyle of tibia and head fibula

- tendon PL superficial and inferior to brevis in retromalleolar groove

- runs in cuboid groove 

- insert plantar surface base of 1st MT and lateral aspect medial cuneiform