1	Online Case Presentation Adult Acquired Flatfoot
2	Clinical Presentation CC: 53 y/o ♀ with Painful bunion & flatfoot HPI: Recalcitrant to functional orthoses, short articulated AFO, and physical therapy. PMH: HTN, MRDD but lives independently PSH: None Meds: Lisinopril All - NKDA
3	Physical Exam What do you notice about this foot?
4	Points of Exam Not Appreciable in Photographs Heel Valgus is non-reducible Hypermobility of the 1^st Ray Gastrocnemius Equinus Pain with palpation over sinus tarsi Inability to perform single heel rise
5	What Other Exams Should You Order? But What Views? And Why?
6	Radiographic Analysis AP Foot Transverse Plane Kite’s Angle Cuboid Abduction 1^st-2^nd IM Angle Peri-talar Subluxation
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8	Radiographic Analysis AP Ankle Ankle Valgus? Is it a Stage 4? Adjacent joint Arthrosis Calcaneal Axial Hindfoot Valgus Or Long Leg Axial Tibial Varum / Valgum
9	"Flexible Deformity?" Flexible Deformity? Joint sparing osteotomies Soft tissue augmentation Tendon transfers Rigid Deformity? Joint destructive arthrodesis Soft tissue augmentation
10	Back to our patient . . . . Non-reducible hindfoot Medial Column Hypermobility Gastrocnemius Equinus
11	Strayer Gastrocnemius Recession
12	Manual Reduction of Deformity via Windlass
13	Post Op Radiographs Fixation: NC & 1^st TMTJ 3.5mm fully threaded Lag Technique STJ 7.3mm Cannulated
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15	Post Op Clinicals Note: Re-creation of longitudinal arch Heel neutral HAV corrected
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