Clubfoot Flashcards
Rate of familial ocurrence?
25% - suggesting a strong genetic linkage
Associated conditions
- Streeter dysplasia (hand anomalies)
- Diastrophic dysplasia
- Arthrogryposis
- Tibial hemimelia
- Myelodysplasia
- Amniotic band syndrome
- Prune Belly Syndrome
- Absent anterior tibial artery
Contracted muscles causing cavus:
- tight intrinsics
- FHL
- FDL
Contracted muscles causing forefoot adductus:
tight tibialis posterior
Contracted muscles causing hindfoot Varus
- tendoachilles
- tibialis posterior
- tibialis anterior
Hindfoot equinus
tight tendoachilles
Bony deformity in clubfoot
- talar neck is medially and plantarly deviated
- calcaneus is in varus and rotated medially around the talus
- navicular and cuboid are medially displaced
Turco View
maximal dorsiflexion foot view, will demonstrate hindfoot parallelism between the talus and calcaneus
Kite’s angle
the AP talocalcaneal angle
- <20 deg in clubfoot
After casting, how long in the brace?
23 hours per day for 3 months, THEN at night until age 4 years
When do you do split tib ant tendon transfer for dynamic supination gait?
at age 2-4 years
- transfer to the lateral cuneiform
The most common cause of recurrence?
poor compliance and education by parents
What is the dorsal bunion?
a dorsiflexed first metatarsal and overactivity of the FHB and abductor hallucis
- also requires overactivity of the tibialis anterior
- peroneus longus weakness
Treatment of dorsal bunion?
- capsulotomy
- FHL lengthening
- FHB flexor to extensor transfer at the MTP joint
Vascular abnormalities in clubfoot?
typically absent anterior tibial artery, dominant posterior tibial artery
- causes intrinsic smallness of the extremity
