Chapter 47- Deformities Of Legs And Feet Flashcards
What is the layman term for congenital talipes equino- varus
Club foot
What are the 4 deformities associated with club foot
- ankle equinus
- hindfoot varus
- forefoot adduction
- cavus
Treatment of club foot
- serial plasters in first few days of life to correct forefoot adduction and hindfoot varus
- equinus deformity is corrected later
- soft tissue surgery may be required ( release of Achilles’ tendon
- neglected cases and special circumstances (Arthrogryposis, myelomeningocoele) further surgery may be necessary
What is the position of the tarso-metatarsal joint, the sole and hindfoot in metatarsus adductus
- forefoot adducted at tarso- metatarsal joint
- sole: convex lateral border, concave medial side
- Hind foot in slight valgus/ normal
Treatment of metatarsus adductus
Spontaneous correction in most cases but if it persists at one year it warrants referral
Cause and presentation of calcaneovalgus
- Due to congenital vertical talus
- presents with rigid flat foot
Persistence of a rotational deformity at what age will tend not to remodel
Age 8
Causes of rotational deformities
- femoral rotation (version)
- tibial rotation
- forefoot position
What is the trans- malleolar axis in adult
About 29 degrees of external rotation
What measurement should one use to assess tibial torsion and what is the normal value
Thigh foot angle, usually it is 15-20 degrees externally rotated
Does femoral anteversion cause in-toeing or out- toeing?
In -toeing
*retroversion will cause out- toeing
When should you refer femoral version?
If they persist to the age of 8 and are symptomatic
In the first year of life, what is the normal amount of lateral bowing of the legs?
15 degrees
What is the adult pattern of valgus?
- 5 degrees of valgus in males
- 7 degrees in females
What pathological conditions should be excluded in genu valgum?
Previous trauma/ infection of growth plate
Rickets
What, on examination, suggests an underlying pathological condition in genu valgum
Very lax medial and lateral collateral ligaments
What is measured every visit in genu valgum
Distance between the malleoli
What operation can be done for genu valgum?
- operation on growth plates of the knee (stapling to inhibit growth on one side of the bone)
What is the cause of Blount’s disease?
Inhibition of the medial growth plate of the proximal tibia
How does Blount’s disease present?
Persistent/ progressive varies deformity of the tibia with internal tibial torsion
What are the two groups of Blount’s disease?
- infantile form
- late onset form
What is the management of Blount’s disease
Referral for corrective osteotomy
What are the causes of rickets? Name the most common
- inadequate Intake or absorption of:
Calcium
Phosphorus
vitamin D - defects in the conversion of vitamin D to actually active form
- end Organ failure to respond to the effects of vitamin D
- most common: renal and those related to cerebral palsy
X-ray findings for rickets
Osteopaenia, thinned cortices, flared or cupped metaphyses, widened epiphyses
Investigations for the evaluation of rickets?
X-rays Ca, Mg, phos PTH vitamin D studies Urinary Ph Renal function
What is done to correct angular deformities in rickets?
Corrective osteotomies and or physeal inhibition
What is the most common type of flat- foot and how does it present?
- hyper- mobile flat foot
- obvious on weight- bearing but disappears in repose/child stands on tip-toe
- joints are fully mobile/ hyper mobile and easy to correct the deformity by grasping the heel and holding it at neutral
- may be slight tightness of tendo-Achilles when the foot is held neutral
- may be generalized ligamentous laxity
When is referral for flat feet necessary?
- if the child is symptomatic : persist and excessive wearing out of shoes, fatigue, inability to keep up with friends, pain in their feet at the end of the day
What are possible causes of rigid flat foot?
- congenital vertical talus
- tarsal condition
- neuromuscular conditions such as cerebral palsy, myelomeningocoele and poliomyelitis
Treatment of rigid flat foot
Specialized surgical procedures
Referral is warranted
What Neurological conditions should be looked for in pes cavus
- charcot- Marie- tooth
- Huntington’s chorea
- myelomeningocoele
What Should one look for on examination of the foot in pes cavus?
- foot drop
- tight tendo-Achille
- fixed hindfoot varus
- fixed cavus
- clawing of the toes
Investigations for pes cavus
AP and lateral standing views of the foot
Nerve conduction studies
Nerve biopsies
