Development of the foot and ankle Flashcards
When does foot disks are recognisable
by week 5, but toes and rays are not yet identifiable
describe the foot development at week 6 of gestation.
14-16 MM
inward rotation continues, leg left
digital rays become more distinct
LF counterclockwise. right clockwise
Describe foot development at week 7?
foot structure is clearly recognisable.
Plantar surface faces medial, dorsal surface lateral
Foot is in equines.
entire lower limb externally rotated.
Describe foot development at the end of 8th week?
continual progessive internal rotation of the thigh and leg with the foot beginning in equinus. supination and external rotation
Describe foot development in 2nd month.
equines of 90 degrees and foot adducted
Describe foot development in 3 month?
equines of 90 and foot adducted and supinated.
Describe foot development in the middle of 3rd month?
Mild equnius and foot supination still present. 1st ray adducted, continual foot dorsiflexion..
describe doot development at 4 months of pregnancy?
Foot pronates and plantar surface faces inferiorly. Equinus resolves. mild metatarsus varus remains.
note: foot pronation continues until unwinding, but still not complete at birth!
describe the foot growth growth from 1st to 3rd trimester.?
1st and second trimester rapidly growing. gets slower at third trimester.
What is the average annual groth of foot length from age 5-12 for female or 5-14 for male?
0.9cm
what age is mature foot length for female and male respectively?
14, and 16
outline the foot length growth from 2-5 years old?
on average,
half shoe size increase every2-3 month until the age of 2yrs
half shoe size increase every 3-4 months from 2-3 years
Hlaf shoe size increase every 4 months from 3-5 years
When does the mesenchymal analges of the distal tibia and fibula seprated?
at Carnegie 17 distal tibia and fibula separated. the talar element is wedged in between.
the distal end of tibia is oblique and concave
when does lateral and medial malleoli are the same length
at carnegie 18 and 20
at which carnegie laterall malleoli extends distally?
22
at which carnegie calcaneofibular contact established and when it is sperated?
20 and 22
at which Carnegie Tibiofibular joint formed?
22
when does Talus forms?
Carnegie 18
Which segment of Talus is formed in TP?
body and Trochlea
Which segment of talus is formed in sp?
talar neck and head
describe each surface of talar element which communicates with other tarsal bone.?
lower surface-calcaneus
anterior navicular
posterolateral surface-lateral malleolus
Posterior medial surface-Tibial plafond and medial malleolus
When does sustentaculum tali appears in embryonic?
at carnegie 22
What is the declination angle of talar neck relative to head???
25
Describe dimentional development of Talus?
Talar body grows more in height and posterior width than length
Talar neck declination angle continues to increase
Talar head turns more laterally relative to the body
unwinding and lateral shift of talar head-reduction of supinated rearfoot posture and adduction of the metatarsus
at which Carnegie posterior lateral and posteromedial tuberosities on the inferior calcaneal surface appear?
carnegie 20
Describe calcaneus embryonic. development?
short with a narrow superior surface
anteromedial segment of superior surface corresponds to the overlapping talus.
Posterior lateral surface supports the distal end of the tibia which resolves in Carnegie 22
sustentaculum tali visible at carnegie 22 extends further medially by 34mm.
when does cuboid ossification occur?
10 month
When is lat cuneform ossification centre
4-20
Med cuneiform
2 yrs
int cuneiform
3yrs
Navicular
2-5 yrs
when does talus starts to ossify
more than 7 month
When does calcaneus starts to ossify
more than 4 months
When does distal phallanux of hallux ossify?
1- less than 3 month
proximal second and 1st phalanx ossifies at
jsut more than 3 months
proximal3-5 ossifies
4- more than 3 month
when does inter-phalangeal ossifies?
5, 2-4 sigits just more than 4 month. 5th digit a lillt more than 4 month
When does shaf of metatarsal ossifes?
2-4 less than 3 month .
1-5 just more than 3 months
how much dorsiflexion is available at new born
excessive Df availabe. dorsum of foot almost touches shin.
what is the position of Tibial plafond
everted parallel to transverse plane by 12 years
what is the postion of rear foot in OKC and ckc
okc rear foot is in varus
ckc rearfoot is in valgus
what is ankle joint plantar flexion rom from new born to 15 yrs old?
30-45
what is ankle joint df of a newborn?
75
what is anke joint df rom of 3 years old?
20-25
what is ankle joint df of 10 yrs old?
15
What is ankle joint df of 15 yrs old?
10
what is foot posture of newborn?
neutral stj position 22 varus
Total stj rom 45
forefoot varus 12-15
metatarsus primus adductus= 8-15
What is the foot posture of a child?
less than 7 year everted due to soft tissue
1st yr 10 everted
what is the formula we used for calculation RCSP?
7-child age+/-2
What are the potential problems with obtaining lower limb
measurements with young children
we get children sit next to partent.
sometimes we may only get observational. for less than 5 years
gestimation is fine
ankle joint equinus?
reduction in ROM of df at ankle joint relative to the age
assessment of ankle joint equnius?
gastroc equinus
soleal equinus
gastroc and soleal equinus
What are the conditions associated with toe walking?
Congenital talpies equinus, autisim, cerebral pulsy, charcot marie tooth, developmental coordination disorder, muscle dystrophy, spina bifida
Describe Os trigonum?
accessory ossicle at posterolateral tubercle of talus
treatment is cast immobilisation and surgical excision
os tibiale eternum
most problematic ossicle
has 3 types
Seasomoid bone within tendon of tib post
Type 2 is most common
secondary ossificationof navicular
Type 3
secondary ossification of navicular and synostosis with navicular body
How to treat os tibiale externum
RICER
CAM WALKER
NWB cast
ARTHERODESIS
surgical managment
os intermetatarsum
between medial cuneiform and based of the 1st and second metatarsals
incidence reported between 1.2-8.2
typically fused to the dorsolateral aspect of medial cuneiform
what does additional digit called?
polydactyly
5th toe most commonly
issues with trippping and shoes fitting
what does fusion of adjecent digits called, describe the aetiology
syndactyly. due to failure of interdigital webbing to regress between adjecent toes during development of week 6
what are the treatment option for curly ro raised digit
may resolve on its own
taping and proper shoe fitting
