Pakistan Orthopaedic & Cosmetology Center – height increase, limb length discrepancies, deformities and muscle imbalances as a result of poliomyelitis, cerebral palsy and other paralysis; correction of leg shapes, surgery of deformation in anterior part of the feet, deformities as a result of neglected and mismanaged orthopedic trauma.

CAVUS FOOT / High Medial Arch foot deformity RECONSTRUCTION

High medial arch foot or pes cavus foot abnormality is a condition causing one to place too much weight and stress on the ball and heel of the foot in erect posture while standing and/or walking.

It is also commonly associated with other foot and ankle deformities like clawing of the toes, posterior hind foot deformity, contracture of the plantar fascia, equinovarus, calcaniovarus and cock-up deformity of the great toe. As a result of pes cavus deformity, one can develop metatarsalgia and calluses because of increased weight bearing over the metatarsal heads.
Types of Pes cavus

Three types based on aetiology, clinical signs and radiological appearance:

Pes cavovarus, the most common. Radiologically the forefoot is plantarflexed in relation to the rearfoot.
Pes calcaneocavus , is mainly seen following paralysis of the triceps surae due to poliomyelitis, the calcaneus is dorsiflexed and the forefoot is plantarflexed. Radiologically there is a large talo-calcaneal angle.
Pes cavus, the calcaneus is highly arched and is neither dorsiflexed nor in varus position. Forefoot is in plantarflexed position on the rearfoot.

Types based on location of APEX of the deformity

Anterior Cavus (Forefoot Cavus)

–Local

–Global

Metatarsus cavus
Posterior Cavus
Combined

Clinical Picture

Lateral foot pain from increased weight bearing on the lateral foot,
instability,
difficulty walking and problems with footwear
metatarsalgia,
pain under the first metatarsal,
plantar fasciitis,
painful callosities,
ankle arthritis,
achilles tendonitis
keratosis
lateral ankle instability
hindfoot varus
The forefoot plantar flexion
hindfoot varus
lower limb stress fractures
knee pain
iliotibial band friction syndrome
back pain
tripping

Medical management

At Pakistan Orthopaedic and Cosmetology Center, our aim of medical management is to allow the patient to ambulate without any problems. It is important for the patient to understand that surgical reconstruction does not provide a normal foot. The main goal of surgical reconstruction is to produce a plantigrade foot and pain relief. Repeated surgical procedures can be necessary, especially if the deformity is progressive. Surgical procedures can be broadly categorized into soft-tissue and bony procedures. Tendon transfers and osteotomies can provide correction of the deformity without requiring an arthrodesis.

Surgical Management

Correcting a cavovarus foot
Most of the corrections involve tendon transfers and capsular and facial releases
Correction of plantar flexion of the first ray by performing a dorsiflexion
ST tarso-metatarsal arthrodesis.
Reduction of hindfoot varus by performing a lateralizing calcaneal osteotomy.
Arthrodesis 1st TMT joint, lateral calcaneal osteotomy for hind foot.

For further details:

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Treatment of Tremors

TREMORS

Tremor can cause significant disability and/or emotional distress.

Tremor is an overactive movement disorder characterized by rhythmic or semirythmic oscillatory movements of one or more body parts. It is due to involuntary contractions of agonist/antagonists muscle pairs.

Some of the common forms are:

Action tremor (AT),
Postural tremor(PT), the rest tremor associated with Parkinson disease (PD).
Occupational tremor (OT)

Tremor is also seen in association with various neurological disorders:

multiple sclerosis,
peripheral nerve entrapment,
metabolic disorders (hyperthyroidism)
Psychogenic

At DR BOTOX Pakistan the most common forms of tremors treated are:

Essential tremor
Dystonic tremor
Parkinson disease tremor

With Botox treatment DR BOTOX achieve excellent results in patients with tremors.

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HEMIFACIAL SPASMS

Hemifacial or half the face spasm (HFS) is a focal movement disorder. It is a:

unilateral,
involuntary,
tonic or clonic contractions or spasms in face muscles innervated by facial nerve.

It can cause:

significant distress to patients,
a sense of facial disfigurement and
social isolation.

It can cause:

involuntary eye closure and
may impair vision and reading.
Drinking, eating and speech may be affected

At DR BOTOX Pakistan, the primary goal of Botox treatment of HFS is to reduce:

involuntary movements and
associated functional limitations and disfigurement caused by HFS.

We strive to improve the patients’ functioning and quality of life.

Botox is considered the standard care for HFS.

Dr BOTOX treats HFS by injecting the affected muscles using very thin hypodermic needles thus achieving excellent clinical results.

To book your appointment for initial assessment contact our practice coordinator.

INDIVIDUALISED MANAGEMENT PLAN for Cerebral Palsy

Cerebral Palsy (CP) is a condition beyond just spastic muscles and abnormal postures and movements. It’s a lifelong disability of varying severity and complexity. As it is obvious in an individual suffering from cerebral palsy that apparent movement and postural disorders are often accompanied by disarrays of:

sensation,
perception,
cognition,
communication,
behavior,
epilepsy, and
musculoskeletal problems

So, it’s multi-faceted and needs a multidisciplinary approach to keep an eye and manage all of the factors that affect a child.

To find out further details, click here.

Winging of Scapulae or Shoulder blades

Scapula winging is caused by severe injury to the muscles that control the scapula or to the nerves that supply these muscles.
At POACC, winging of scapulae is managed both by conservative and surgical approach.
For your assessment at POACC, contact our practice coordinator.