15.11.3 Paediatric Foor Deformaties Flashcards

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1
Q

Clubfoot
Def
Epidemiology

A

Def
- Hindfoot
➡️Equinus
➡️Varus
- Midfoot
➡️Cavus (high arch in middle of foot)
- Forefoot
➡️Adductus

CAVE (how deformity corrects) -> Cavus, Adductus, Varus, Epuinis

Epidemiology
- Most common congenital deformity 1/1000 (Maori 6.8 per 1000)
- Males > females 2x
- 50% bilateral
- 80% isolated deformity (IDIOPATHIC)
- Associated conditions (SYNDROMIC/ NEUROMUSCULAR)
Distal Arthrogryposis
Spinal bifida
Amniotic band syndrome
Tibial hemimelia
Congenital myotonic dystrophy
- 7% another anomaly; 7.6% neurodevelopmental condition

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2
Q

Clubfoot pathophysiology

A

Begin as limb buds form
Abnormally dense collagen fibres in medial and posterior structures (Achilles, tib post tendons; tibionavicular and calcaneonavicular ligaments)
Diagnosed on U/S from 12 weeks gestation Genetic component (25%)- family history
Polygenic cause influenced by external factors (maternal smoking), Maternal diabetes
Alcohol consumption
Seasonal variation – maternal temperature during embryonic development In utero positioning
Syndromic more severe and resistant to treatment

Went through this very quick

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3
Q

Idiopathic clubfoot

A
  • not a packing disorder
  • Can be associated with
    ➡️Hip dysplasia (25x more likely)
    ➡️Torticollis
  • On exam
    ➡️Small foot and calf
    ➡️Shortened tibia
    ➡️Medial and posterior skin creases
  • X ray not needed
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4
Q

Pirani score

A

Slide 6

Implications
- Higher score at beginning of treatment correlates with increase in number of casts and increase requirement for Achilles tenotomy
- Helps with counselling parents Monitors progressive correction

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5
Q

Ponseti

A
  • Weekly, serial casting
  • Fulcrum is head of the talus, SUPINATION around the talus
  • Gradual correction
  • Pirani score weekly should decrease
  • Average 6-8 casts
  • After casts: Achilles tenotomy (percutaneous) and POP for 3 weeks
  • Then: Abduction foot orthosis (Dennis Brown boots/ Mitchell boots)
  • Abduction up to 60 degrees relative to tibia
  • Then dorsiflexion, need 20-30 degrees, if not, Achilles tenotomy (805 of cases)
  • Hidfoot varus will correct
  • Avoid fingers on calcaneus
  • Avoid pronation
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6
Q

Abduction foot orthoses

A
  • Dennis Brown
  • Mitchell
  • Full time wear (23/24 hours) for 3 months
  • Then nap times and night time for 4 YEARS Affected foot 70 degrees
  • Normal foot 40 degrees
  • Shoulder width
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7
Q

Bracing

A
  • Compliance is crucial
  • Recurrence up to 80% if poor compliance (6% if compliant)
  • Family education is crucial
  • 4-5 year commitment
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8
Q

Dynamic supination

A
  • After walking, usually 2-3 years (over 30 months)
  • Foot well corrected, but dynamic supination still present
  • Surgery: Tibialis anterior transfer
  • Internal splint to decrease supination 20% of cases
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9
Q

Relapse

A
  • Common
  • Non-compliance
  • Overactivity of tib ant tendon
  • Progressive neuromuscular disease
  • EVAC – Equinus FIRST
  • What to do?
  • Re-Ponseti!
  • Can do repeat Achilles tenotomy
  • If recurrent and stiff – may need surgery (bony and soft tissue surgery)
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10
Q

Complications

A
  • Recurrence
  • Residual cavus
  • Pes planus
  • Undercorrection
    Intoeing gait
  • Osteonecrois of talus
  • Flat top talus
  • Dorsal bunion
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11
Q

CVT

A
  • congenital vertical talus
  • rigid flat foot in baby
  • mostly syndromic
  • Persian slipper
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12
Q

Pes planus (flat foot)

A
  • rigid or mobile/ flexible flat feet
  • no medical arche
  • hindfoot in valgus
  • toes peeking out in lateral side
  • assess wheter rigid or mobile by letting pt stand on toes (if it corrects from … -> …)

Flexible
- 25% adults
- Ligaments laxity often the cause
- Could be tight achilles
- Often asym and pain free
- Treatment is often conservative

Rigid
- Most common from a tarsal coalition (fusion)
- Between talus and calcaneus
- Or navicular and calcaneus
- Can complain of pain or asymptomatic
- Treatment is surgery to remove the fusion

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13
Q

Polydactyly

A

Extra finger
- Very common
- Pre-axial and post axial
- Need x rays to check if bones in foot also
- Duplicated
- Surgery is recommended to make shoewear easier
- Check hand for extra finger too

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14
Q

Local gigantism

A
  • Non-hereditary condition
  • Can be associated with syndromes
  • Can be due to overgrowth from:
    ➡️Fat
    ➡️Vascular
    ➡️Cosmetic problems
  • Treatment is difficult, often better to amputate the affect digit
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15
Q

Cavo varus feet

A

High arch feet
- High arched feet
- Most associated with neurological
- Cause
➡️Like Charcot-Marie-Tooth
➡️c/o ankle sprains
- Treatment can be conservative and then
- Surgical
- Conservative: insoles, splints

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