Exam and Treatment of Orthopedic Conditions Flashcards
3 types of foot deformities
- metatarsus adductus
- calcaneovalgus
- club foot
Metatarsus Adductus
- Forefoot is curved medially;
- hindfoot is in a normal
amount of slight valgus, - full dorsiflexion range of
motion is present
3 grades of metatarsus adductus
- Grade I = flexible with ability to correct beyond midline
- Grade II= moderately correctable with ability to correct to midline
- Grade III=severe with inability to achieve midline
metatarsus adductus exam
- Tracing or photo of foot
- Stroke/tickle lateral border of
foot, watch for spontaneous correction - Evaluate PROM
Metatarsus Adductus Treatment
- Grade I: Monitor – Usually
resolves on its own - Grade II: Corrective shoes
(Straight-last or Reversed-last) - Grade III: Manipulation,
casting/splinting, and corrective shoes
When is orthopedic surgery considered for grade III metatarsus adductus
- when conservative treatment is ineffective
- older than 4 yo
positional calcaneovalgus
- Excessive dorsiflexion, hindfoot valgus,
and forefoot abduction - no treatment needed
congenital calcaneovalgus caused by vertical talus
- Talus is vertically oriented, navicular is displaced onto the dorsal surface of the talus – “rocker bottom foot”
- Requires surgical correction
clubfoot
- Midfoot/forefoot CAVUS
- Midfoot ADDUCTUS
- Subtalar VARUS
- Ankle EQUINUS
clubfoot treatment
- Ponseti serial casting
- comprehensive release
femoral antetorsion causes
Structural, muscle imbalance, abnormal muscle tone
femoral antetorsion exam
Ryders/Craig’s test, Trochanteric Prominence test
Femoral antetorsion treatment
- May resolve naturally
- Discourage W-sitting
- Braces, twister cables, shoes (not typically effective if structural)
- Surgery after 10-14 y/o
tibial torsion cause
Uterine positioning, muscle imbalance,
abnormal muscle tone
tibial torsion exam
Thigh-foot angle, transmalleolar angle
tibial torsion treatment
- Watch until after 18 m/o
- Denis-browne shoes and bar, Friedman counter splint
- Surgery after 8 y/o
in-toeing/ out-toeing causes
- Femoral torsion
- Tibial torsion
- Metatarsus adductus/abductus
developmental dysplasia of the hip - condition
- Seen at birth due to poor development
of the joint capsule, ligamentous laxity, intrauterine positioning - Generally posterior and superior
- Can lead to avascular necrosis
developmental dysplasia of the hip screening
- asymmetric skin folds
- limited hip abduction (should be 75-80)
- Galeazzi test (greater than 1 yo)
- Ortolani test ( <2-3 mo)
- Barlow test (<2-3 mo)
Ortolani Test
- Detects hip dislocation
- Distract and abduct leg with hip flexed to 90 degrees – feel “clunk as head of femur goes back into place
Barlow Test
- Detects hip instability
- Apply downward pressure to a flexed
conservative treatment of developmental dysplasia of the hip
pavlik harness
- abducted, ER, flexed
acquired hip dislocation caused by
- Muscle imbalance * Spasticity * Positioning * Trauma
screening for acquired hip dislocation
- Pain
- Galeazzi
- Skin fold asymmetry
- Gait
- Unilateral: Trendelenburg on involved side
- Bilateral: Waddling gait
Treatment for Aquired hip dislocation
- Pavlik Harness
- Abduction orthosis
- Orthopaedic surgery after 2 y/o
limp due to trendelenburg gait
- Lean toward involved side
- Usually related to hip problem
limp due to antalgic gait
- Decreased stance time on involved side
- Usually related to foot, ankle, or lower leg problem
Under 4 y/o with a limp
- Rule out trauma
- Most likely related to infection (osteomyelitis, septic arthritis)
Legg Calve Perthes Disease
- Typically 4-10 y/o but can occur up to 12 y/o
- Males: Females – 4:1
- Cause unknown but may be related to exposure to 2nd
hand smoke and poor nutrition - Positively correlated with learning disabilities and ADD
- Positive Trendelenburg – hip pain or abductor weakness
- Limited abduction and IR ROM
- Pain in groin, hip or knee
4 stages of LCP
- initial stage
- feagmentation
- re-ossification
- healed
LCP Acute treatment
abduction brace,
decrease weight bearing
LCP gait training
after surgery or in residual stage
Sever’s Disease was in sports injury lecture
not doing that again
slipped capital femoral epiphysis
- Posterior-inferior displacement of femoral head on femoral neck due to growth plate failure
- 60% bilateral
- Males > females
slipped capital femoral epiphysis symptoms
- Decreased hip ROM in flexion, abduction, IR – If hip is flexed, see increased ER
- Pain at groin, anteriomedial thigh and knee
- antalgic gait
- gonna need surgery
osgood schatter was also in sports injury
growing pains
- kids 3-12
- nonarticular, pain occurs late in the day or at night, lasts
minutes to hours, episodic
Physical therapy for mild curves
- the schroth method
- visual feedback, breathing, postural ed to re-establish where midline is
Spondylolisthesis
- seen in kids who participate in sports w/ repetitive lumbar hyperext (gymnastics)
spondylolisthesis symptoms
- Back pain
- L5 radiculitis
- Shortened trunk
- Palpable lumbosacral stepoff of a spinous
- Anterior pelvic tilt with increased lumbar lordosis
- Heart-shaped buttock appearance
- Hamstring tightness
spondylolisthesis treatment
- Activity modification
- Strengthening/Stretching
- Bracing
- Surgical stabilization/fusion if Grade 3
and above or if progressive - Decompression if L5 radiculopathy is
persistent - Surgical repair of pars interarticularis
