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AAOS Atlas of Orthoses and Assitive Devices > Chapter 35: Congenital and acquired disorders > Flashcards

Chapter 35: Congenital and acquired disorders Flashcards

1
Q

What is growth?

A

An increase in physical measurements

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2
Q

What is Development?

A

The acquisition and refinement of skills that follow a constant sequence, although at a rate that shows a wide range of normal variation.

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3
Q

What is one unique characteristic of orthoses in pediatric patients?

A

Opportunity to mold and guide the growing and developing body.

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4
Q

What is the cause of intoeing?

A 
Metatarsus adductus (MA)
The forefoot is adducted
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5
Q

What is the anatomical site of metatarsus adductus?

A

The Tarsometatarsal joint
The medial cuneiform-first metatarsal articulation often is oblique and there is an alteration in the size and shape of the first cuniform.

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6
Q

What makes MA more likely clubfoot?

A

A rigid heel varus with MA.

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7
Q

What are the signs of clubfoot?

A

The calcaneous is resistant to equnus and the foot as a unit cannot be passively dorsiflexed normally at the ankle.

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8
Q

What are the three types of MA?

A

Type I: foot actively corrects wtih stroking or tickling the lateral foot
Type2: foot corrects only with passive stretching
Type 3: foot cannot be passively corrected.

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9
Q

Treatment of MA is based on what?

A

Severity
Flexibility
and patient age.

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10
Q

For a flexible MA of a patient 6 motns or less, what was the treatment?

A

Stretching the foot four to six times a day, with 10 repetitions and the foot held in that position for 6 seconds.

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11
Q

What is the treatment for infants and toddlers with a more rigid MA?

A

Serial manipulation and casting.

The casts should be with the knee flexed, and forefoot abducted and the foot somewhat externally rotated.

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12
Q

What type of shoes are used to correct MA?

A

Orthopedic or corrective shoes

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13
Q

What is a reverse last shoe?

A

Also known as a Tarsal pronator shoe

IT turns outward at the midfoot to maintain the abducted position acchieved by correction

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14
Q

What is a straight last shoe?

A

Remains straight and maintains a less drastic abducted position.

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15
Q

What is the Bebax shoe?

A

A shoe designed with an adjustable multidirectional hinge between the hindfoot and forefoot sections.

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16
Q

What should not be used for MA?

A

Joining the shoes with a denis-Browne bar because it produces correction through the subtalar joint leading to heel valgus and flatfoot.

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17
Q

What is another orthosis that can be used to treat MA?

A

The Wheaton brace

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18
Q

What is the Wheaton brace?

A

KAFO or AFO with an extgended medial sidewall to prevent forefoot adduction.
It is made with an outward flare shape to the foot section

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19
Q

What is skewfoot?

A

It presents as MA with heel valgus. (a corkscrew alignment of the foot is seen.
The forefoot is in adduction with some degree of supination, while the hindfoot is in abduction with significant valgus. A key finding is lateral displacement of the navicular on the talus.

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20
Q

What is the treatment for skewfoot?

A

Surgery
Serial casting
FO (for adults to accomodate the deformity)

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21
Q

What is the other name for club foot?

A

Congenital talipes equinovarus

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22
Q

How can club foot be recognized?

A

The cosmetic appearance resembling a club on the end of the leg.

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23
Q

What percent of clubfoot occur in males?

A

70%

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24
Q

Which foot is usually for affected by club foot?

A

Right foot.

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25
Q

Club foot is common in what conditions?

A

Spina bifida
Diastrophic dwarfism
Arthropryposis
Amniotic band syndrome.

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26
Q

Physical examination of club foot presents as what?

A

Equinus and varus of the hindfoot, with adduction and supination through the midfoot.
This combination brings the medial side of the great toe and first met adjacent to the medial distal tibia.
A tranverse crease is almost always present across the midfoot in the medial longitudinal arch.
Shortening of the limb.

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27
Q

What are the most commonly used orthoses to treat clubfoot?

A

Straight last and reverse last shoes.

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28
Q

The effectiveness of straight last and reverse last shoes depends on what?

A

The ability of the relatively stiff heel counter to control the hind foot while the material of the medial side of the toe box pushes against the first ray of the forefoot.

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29
Q

What type of shoe might be mandatory once a child has some finger dexterity?

A

A high-top design, augmented with a strap over the dorsum of the ankle.

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30
Q

What is the Denis Browne bar?

A

A treatment for club foot.
It has adjustable foot-plates with screw attachments designed to match threaded plugs in the soles of certain corrective shoes.
It is adjusted to keep the feet externally rotated, augmenting the forefoot abduction forces of the shoes and external rotation stretch at the ankles.
The length of the bar should be the width of the child’s pelvis

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31
Q

What is the fillauer bar?

A

A treatment for club foot.
It has adjustable metal clamps designed to grasp the sole of the patient’s shoe.
It is adjusted to keep the feet externally rotated, augmenting the forefoot abduction forces of the shoes and external rotation stretch at the ankles.
The bar can also be bend, center downward and away from the patient to include a valgus moment at the hindfoot.
The length of the bar should be the width of the child’s pelvis

32
Q

How are AFOs and KAFOs adapted to treat club foot?

A

The foot section incorporates an outward flare and an extended medial side wall to ensure abduction through the midfoot. Valgus and external rotation shaping can be added to the orthosis as appropriate.

33
Q

What is the ponseti method?

A

It begins with serial manipulations and holding casts holding the foot in supination to correct the cavus component. The forefoot is abducted in supination, with counter pressure over the dorsolateral head of the talus.
Then a Ponseti orthosis is used. It is an abduction orthosis consisting of straight last shoes attached to the Denis-Browne bar with the footplates set at 70 degrees out-toe, and with the bar bent to encourage hindfoot valgus and about 15 degrees of ankle dorsiflexion.

34
Q

How long is the Ponseti orthosis worn?

A

3 months or until the child begins to crawl.

Then night bracing is continued to age 3 or 4.

35
Q

What are the different names of Congenital Vertical Talus?

A

Congenital convex pes valgus
Rocker-bottom foot
Persian slipper foot

36
Q

What is the physical conditions of congenital vertical talus (CVT)?

A

Heel is fixed in equinus
Forefoot dorsiflexed and everted
The arch is convex, and the head of the talus is prominent medially in the sole.
The foot has a rocker-bottom appearance. and is rigid and uncorrectable.

37
Q

What is the important defining characteristic of congenital vertical talus (CVT)?

A

A fixed dorsolateral dislocation of the navicular onto the neck of the talus.
The sustentaculum tali and spring ligament are incompetent.

38
Q

Treatment of CVT includes what?

A

Passive manipulation and holding casts.
The casts should gradually reduce the taolnavicular joint by manipulations suggestive of a reverse ponseti.
Orthoses are usually advised after surgery to maintain correction.

39
Q

What is calcaneovalgus foot?

A

The forefoot is abducted and dorsiflexed with the dorsum lying againsts the anterior leg, and the heel is in calcaneus with valgus.
The ankle cannot be plantarflexed beyond neutral.
The foot is mostly flexible.

40
Q

What distinguishes calcaneovalgus foot with CVT?

A

The flexibility and the position of the heel in calcaneus rather than equinus distinguishes calcaneovalgus foot from CVT.

41
Q

What is the treatment of Calcaneovalgus foot?

A

Passive plantarflexion stretching

An AFO in plantarflexion and the foot adducted can be used.

42
Q

What is often seen with flexible flatfoot?

A

Heel cord contracture

43
Q

What is incorporated in a UCBL?

A

A sustentaculum Tali mold to directly resist collapse through the subtalar joint and a heel cup to control hindfoot valgus.

44
Q

Tarsal coalition is a frequent cause of what?

A

Rigid hindfoot, with or without flatfoot posture.

45
Q

What is Tarsal Coalition?

A

Partial or complete fusion of the tarsals.
It can be fibrous, cartilaginous, or bony.
The most common is between the calcaneus and navicular or between the talus and calcaneus.

46
Q

What are the symptoms of tarsal coalition?

A

Activity related midfoot pain.

Repeated ankle sprains.

47
Q

What is symptomatic accessory navicular (AN) bone?

A

Accessory bones usually liying on the medial plantar border of the navicular bone.
It may be separate or connect by synchondrosis, or fused.
A portion of the posterior tibialis tendon inserts into the AN.

48
Q

Asymptomatic AN may be mistaken for flatfoot why?

A

Because the AN fills the medial arch

49
Q

What is contraindicated for patients with AN?

A

Rigid arch supports. It puts more pressure on the bone

50
Q

What can be used to treat AN?

A

A soft navicular cookie or heel seat cup with medial wedge.

51
Q

What is a cavus deformity?

A

Excessively high arch resulting from a varus deformity of the hindfoot and a plantarflexed equinus deformity of the forefoot.

52
Q

What is Kohler disorder?

A

Uncommon disorder that is the characteristic source of medial midfoot pain in children 4-7
It changes the tarsal navicular to mimic the avascular fragmentation and regeneration phases of Legg-Calve-Perthes disorder of the hip. The final healing almost always includes minor diminution of the size of the navicular.

53
Q

What is the treatment of Kohler disorder?

A

Orthoses that support the arch and decrease stress across the posterior tibialis and tarsal navicular.

54
Q

What are the possible causes of bunion (hallux valgus) in children?

A

Metatarsus primus varus, ligamentous laxity, hypermobile forefoot, pronation of the foot, pes planus, structural anomalies of the first met head, overtreatement of MA, excessively long metatarsals.

55
Q

What treatment can be used for bunions?

A

Nighttime hallux valgus splints

56
Q

How does Freiberg infraction present?

A

Pain and swelling directly at the involved joint.
It is more common in females.
Mixed sclerotic and lucent changes are seen in the involved met head with flattening of the articular surface.

57
Q

What is the technical term for bowlegged?

A

Genu varum

58
Q

What is the technical term for knock-kneed?

A

Genu valgum

59
Q

What is the normal distance that should be seen between the knees of children when their ankles are touching?

A

10cm

60
Q

What is another name for Blout’s disease?

A

Tibia vara

61
Q

How does tibia vara present?

A

A progressive bowing deformity, resulting from disordered growth of the proximal medial physis and metaphysis of the tibia.
There is often ligament laxity, a lateral thrust at the knee in stance, and a palpable “beak” at the proximal medial tibia.

62
Q

Most children with Blout’s disease are what?

A

Obese and early walkers.

Can’t determine disease until 18-24 months

63
Q

What angle of the metaphyseal-diaphyseal angle of the proximal tibia demonstrates the progression to tibia vara?

A

16 degrees

64
Q

What treatment can be done for patient’s with Blout’s disease?

A

Treatment only for patients younger than 3.
Bracing provides a force at the medial side of the proximal thigh and medial malleolus with an opposing lateral support at the knee.
You want control of flexion of the knee and rotation of the leg.
An A-frame brace, or KAFO can be used.
It should have a medial thigh cuff that extends past the medial tibial plateau, a single medial upright with drop-locking knee joints from which an elastic strap wraps around the upper calf, and tibial growth extensions attached to a shoe or footplate through a freemotion ankle joint.

65
Q

Anterior bowing may be associated with what?

A

An absent or hypoplastic fibula.

Dimpling of the skin of the anterior leg usually identifies more fibular involvement.

66
Q

What are the other names for anterior bowing?

A

Fibular hemimelia

Postaxial hemimelia

67
Q

What is the main problem of anterior bowing?

A

Tibial shortening

68
Q

Posteriormedial bowing is associated with what?

A

A calcaneus or calcaneovalgus foot deformity, triceps weakness, extension contracture of the ankle and anisomelia.

69
Q

What is the possible treatment of posteriomedial bowing?

A

Custom molded AFOs that help stretch the anterolateral soft tissues at the ankle.

70
Q

Anterolateral bowing represents the mildest expression of what?

A

Pseudarthrosis of the tibia.

71
Q

Anterolateral bowing with or without pseudarthrosis is associated with what?

A

Neurofibromatosis

72
Q

What treatment can be used for anterolateral bowing?

A

Nonarticulated plastic KAFOs for infants
When the infant stands, then the addition of an anterior molded panel to create total contacct should be added.
Older infants and young children: Articulated KAFO
Older children: high AFO

73
Q

What is Radial dysplasia (radial clubhand)?

A

A failure of longitudinal formation of the preaxial side of the upper limb.
The thumb, radial side of the carpus, and radius may be hypoplastic or completely absent.

74
Q

Radial dysplasia is often associated with what other syndromes and malformations?

A

Thrombocytopenia absent radius (TAR)
Holt-Oram syndrome
VACTERL association (vertebral anomalies, imperforate anus, cardiovascular anomalies, tracheoesophageal fistula, renal anomalies, and limb bud failures.)

75
Q

What treatment can be done with Radial dysplasia?

A

An orthoplast or similar thermal-labile plastic splint that can be succesively adjusted into mor eulnar deviation as the child grows.

AAOS Atlas of Orthoses and Assitive Devices (40 decks)

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