Cortex - Paediatric orthopaedics 5

Question 1

What are the 3 main pathologies relating to the foot and ankle discussed ?

Answer 1

• Talipes Equinovarus (clubfoot)
• Tarsal coalition
• Hallux valgus

Question 2

What is Talipes Equinovarus (Clubfoot)?

Answer 2

It is a congenital defmority due to in utero abnormal aligment of the joints between the talus, calcaneus and navicular bone

Question 3

Does Talipes equinovarus (clubfoot) run in families ?

Answer 3

Yes

Question 4

Describe the typical presentation of talipes equinovarus (clubfoot)

Answer 4

Deformity consisting of ankle equinus (plantarflexion) - movement of the foot in which the foot or toes flex downward toward the sole, supination (outwards role of the foot) and varus alignment of the forefoot

Question 5

What is the treatment of talipes equinovarus (clubfoot)?

Answer 5

Splintage with the Ponseti technique (commenced asap after birth)

80% of children require a tenotomy of the Achilles tendon (a minor procedure) to maintain full correction.

Once full correction is achieved the child is then placed in a brace

Question 6

What is hallux valgus ?

Answer 6

Often referred to as “a bunion,” is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. (think dad has this on his feet)

Question 7

Is back pain in a child/adolescent a red flag ?

Answer 7

Yes! not normal to have this

Question 8

What is scoliosis ?

Answer 8

It is a lateral curvature of the spine

Question 9

What are the typical signs of scoliosis ?

Answer 9

Typical signs include:

• A visibly curved spine
• One shoulder being higher than the other
• One shoulder or hip being more prominent than the other
• Clothes not hanging properly
• A prominent ribcage
• A difference in leg lengths

Question 10

What does painful scoliosis warrant ?

Answer 10

Urgent MRI to look for e.g. tumour or infection

Question 11

What is the treatment of scoliosis ?

Answer 11

• Mild, non-progressive - no surgery
• Larger curves - may require surgery for cosmetics
• Serve may cause breathing difficulties and require surgery

Question 12

What is Spondylolisthesis?

Answer 12

Is slippage of one vertebra over another and usually occurs at the L4/L5 or L5/S1 level.

Question 13

Describe the typical presentation og spondylolisthesis

Answer 13

Symptoms can include:

• lower back pain – which is usually worse during activity and when standing, and is often relieved by lying down
• pain, numbness or a tingling sensation radiating from your lower back down your legs (sciatica) – this occurs if the slipped vertebra presses on a nerve
• tight hamstring muscles
• stiffness or tenderness in your back
• excessive curvature of the spine (kyphosis)
• can present acutely with a characteristic waddling gait.

Question 14

What is the treatment of spondylolisthesis ?

Answer 14

• Mild slippages - rest and physio
• Severe - may require stabilisation and possibly reduction

Question 15

What is tarsal coalition and recall what it can lead to

Answer 15

• This is a condition where there is an abnormal bridge (bony, fibrous or cartilaginous) between the calcaneus & navicular or between the talus and calcaneus.
• It can lead to a painful fixed flat foot deformity in older children.

Question 16

What is the treatment of tarsal coalition leading to painful fixed flat feet ?

Answer 16

• 1st line = Splintage / orthotics
• 2nd line = resistant pain may require surgery to remove the abnormal connection.