Childrens Orthopaedics Flashcards
give 4 congenital foot conditions?
clubfoot
rocker bottom foot
neurofibromatosis
skeletal dysplasia
give 4 neuromuscular disorders of feet
cerebral palsy
tip toe walking
Duchenne muscular dystrophy
high arch (cavus)
what are the 4 features of clubfoot?
CAVUS Cavus Adductus Varus Equinus
what is clubfoot and what causes it?
birth defect causing abnormal foot posture
can be idiopathic or associated with other more serious conditions
what is postural talipes?
normal curved posture of newborns
looks like clubfoot but can be forced into normal position
how is clubfoot treated?
ponseti method of casting
what is rocker bottom feet?
congenital vertical talus due to irreducible dislocation of talus on navicular
what are the features of rocker bottom feet?
round plantar features
equinus hindfoot
common feature of clubfoot and rocker bottom feet?
fixed ankle equinus
what is neurofibromatosis?
congenital disorder affecting extremities, spine and skin
what causes neurofibromatosis?
autosomal dominant inheritance of NFI gene Ch17
how is neurofibromatosis diagnosed?
2 out of the following 7 present >6 café au lait spots 2 or more neurofibromas/plexiform neurofibromas freckling axilla/inguinal region optic glioma 2 or more lisch nodules cortical thinning/pseudoarthrosis first degree relative affected
what is skeletal dysplasia?
congenital disorders involving bone and cartilage
what are the features of skeletal dysplasia?
shortening of involved bone short stature (usually <2 SD) - can be proportionate or disproportionate
what is the most common form of skeletal dysplasia?
achondroplasia normal trunk/short limbs frontal bossing genu varum normal intelligence motor delay
what causes achondroplasia?
fibroblast growth factor receptor 3 FGFR3
either autosomal dominant or spontaneous mutation
what is cerebral palsy?
non-progressive neuromuscular disorder causing injury to immature brain (<2 years)
- prematurity
- perinatal (infection, injury, meningitis)
what are the features of cerebral palsy?
UMN disease (muscle weakness/spasticity) early = abnormal muscle forces > dynamic deformity late = contractures, deformity, dislocation head unaffected?
what is clasp knife spasticity?
where abnormally increased resistance to stretching of a muscle gives way abruptly, usually near the end of the range of joint movement
seen in cerebral palsy
how is cerebral palsy functionally diagnosed?
walking
non-walking
how can cerebral palsy be treated?
benzodiazepines baclofen
selective dorsal rhizotomy
botulinum toxin
what is Duchenne muscular dystrophe?
commonest muscular dystrophy
X linked recessive disorder causing progressive muscle weakness
what causes duchenne muscular dystrophe?
absence of dystrophin protein
replacement of muscle with fibrofatty tissue
how does Duchenne muscular dystrophy present?
2-5 yrs old muscle weakness (prox > distal) clumsy walking positive gowers sign scoliosis
how is Duchenne muscular dystrophe diagnosed?
creatinine phosphokinase muscle biopsy (absence of dystrophin)
what is gowers sign?
cant stand up from knees alone
use hands to walk up the legs to stand upright
what is cavus feet?
pes cavus (high arched foot) elevated longitudinal arch and varus hindfoot
what causes cavus feet?
idiopathic/familial
2/3 due to neurological disorder (polio, cerebral palsy, myelomeningocoele, SCI)
charcot marie tooth
how is cavus feet assessed?
X rays
Coleman block test
how is cavus feet managed?
conservative
surgery
- soft tissue
- bony (osteotomy)
