[Phlebology and podiatry]. / Phlébologie et podologie.

By their tensing and relaxation, the muscles of the leg are thought to be responsible for compressing and relaxing the vascular walls and the lumen of vessels. In order to study the way the muscle structure of the lower limb (in particular the leg and the foot) functions, it is necessary to understand the step and break down its components. The weight of the body is transmitted to the ground by the astralagus which distributes the different forces throughout the fives systems of ossei trabeculae of the astralagus and the heel. The valgus heel determines a continuous traction on the tendon and the hind leg muscle which determines with time a dragging of the foot. When the body goes forward, the weight levels the transverse fore arch. The flexor muscles of the toes bend the phalanxes, gripping them to the ground, they avoid the falling forward of the body with the proximal insertion on the tibia. The sesamoids increase the muscles power as well as that of the kneecap on the quadriceps. The internal curvature of the foot on the ground is furthered by the decreasing length of the metatarsal bones. This is counterbalanced by the long fibular muscle which lowers the medial axis and raises the external axis. The supination of the forefoot depends only in part on the varus valgus of the rear of the foot. The plantar aponeurosis and the flexor tendons have an impact on the metatarsi because they increase the power and bring the insert closer. The complex articular system of the feet depends on the extrinsic and intrinsic muscle structure which, at the same time as a position variation can also play an important part in the venous alteration.

The surgical treatment of valgus flat foot in the adolescent by osteotomy of calcaneum associated with tenodesis of tibialis anterior and posterior.

In the treatment of valgus flat foot in adolescent patients, when growth has nearly ceased (about 13 years in the female and 15 in the male) the operation of choice is varus osteotomy of the calcaneum, stabilised by a homoplastic bone wedge, together with tenodesis of tibialis anterior and posterior. At this age, skeletal growth is not sufficient to guarantee corrective evolution of the deformity after repositioning of the calcaneo-talar joint by any surgical technique. Varising osteotomy of the calcaneum offers the advantage of avoiding sacrifice of the calcaneo-talar joint, as in the Grice-Green arthrodesis, which although indicated for the paralytic valgus flat foot, is not appropriate in the idiopathic variety.

Pes cavus: treatment by naviculo-cuboid osteotomy.

The treatment of pes cavus in the adult by the V osteotomy of Japas has several advantages if performed before the onset of secondary arthritic degeneration. The correction is carried out at the apex of the cavus and is technically simple. Consolidation is rapid, and correction is achieved with no significant sacrifice of movement. The authors describe a modification of the medial part of the osteotomy line which was devised because of the difficulty of controlling the various fragments of navicular and cuboid during reduction in the original technique, as well as a significant incidence of osteonecrosis in some of these fragments. This modification involves only the naviculo-cuboid joint and spares the other joints, thus reducing postoperative articular stiffness to a minimum.

Treatment of symptomatic first metatarsal shortened by surgery.

There are several complications that can result from shortening of the first metatarsal in the treatment of bunion. Metatarsalgia and recurrent deformity can be quite disabling. The surgical technique described in this brief report provides improved support of the metatarsal heads in walking while decreasing pain and enables the patient to stand for longer periods of time. The procedure is reserved for salvage of those patients with severe pain and deformity and in whom other salvage procedures have failed.

The surgical treatment of mobile valgus flat foot in children.

The indications for surgical intervention in the treatment of mobile valgus flat foot in children are based on the age of the patient and the severity of the lesion. This depends on an accurate pre-operative assessment based on many clinical and radiographic signs and is the only way of deciding when orthotic treatment and physiokinesotherapy should be replaced by surgery.