Foot, Ankle and Spine Conditions Flashcards
Talipes equinovarus is also known as what?
Clubfoot
Is it common for clubfoot to be bilateral?
50% of cases
What happens in utero to cause clubfoot?
Abnormal alignment of the talus, calcaneus and navicular bones
The abnormal development in clubfoot causes contractures of the soft tissues which results in what deformities?
Ankle plantar flexion (equinus), forefoot supination and varus
Which sex is clubfoot more common in?
Boys
Apart from male sex, what are some other risk factors for clubfoot?
Family history, breech position, oligohydramnios, skeletal dysplasia
What condition should all babies with clubfoot be screened for at birth?
DDH (ultrasound)
What treatment is used for clubfoot? What are the outcomes of this?
Ponseti technique (splintage), asap after birth. 90% of cases are successful.
What are the 2 steps of the Ponseti technique?
1st- casting for 9 weeks, 2nd- boots and bar for 23 hours a day for 3 months, then at night only up to 4 years
When do cases of clubfoot require surgery?
If recurrent or a delayed presentation
What can occur in delayed cases of clubfoot?
Fixed deformities with the child walking on the outside of their foot
What are the outcomes of delayed presentations of clubfoot?
Difficult to correct and extensive surgery with poor results
To maintain full correction, most cases of clubfoot require what operation?
Achilles tendon tenotomy
What happens in tarsal coalition?
There is an abnormal bridge between the calcaneus and navicular, or the talus and calcaneus
What can tarsal coalition lead to?
Painful fixed flat feet in older children
What treatment can be used for tarsal coalition?
Splintage/orthotics, but if the pain is resistant then may need surgery
When can hallux valgus appear in younger people? What is it associated with?
In late adolescence, normally has a strong family history
What is the problem with surgical correction for hallux valgus in adolescents?
There is a high risk of recurrence and deformities later in life
What is the likelihood that back pain in adolescents and children is serious?
It is always a red flag so worth getting checked out
What are some causes for scoliosis?
Idiopathic (most common), tumours, neuromuscular disease, skeletal dysplasia, infection
Idiopathic scoliosis is most common in who?
Females, usually presenting with concerns regarding appearance
Scoliosis which has an underlying cause usually occurs in who?
Younger children
Any scoliosis which is painful warrants what?
MRI for tumour/infection
Do all cases of scoliosis require surgery?
No, only larger curves with cosmetic problems or to improve wheelchair posture
Severe cases of scoliosis can result in what?
A restrictive lung defect- surgery is required to prevent breathing difficulties
What does surgery for scoliosis involve?
Vertebral fusions and long rods connecting the posterior elements of the spine
Correction of large deformities in scoliosis has a risk of what?
Spinal cord injury
What is spondylolisthesis?
The slippage of one vertebra over another
Where is spondylolisthesis most common?
L4/5 or L5/S1 levels
What can cause spondylolisthesis?
A developmental defect or a recurrent stress fracture which fails to heal
When does spondylolisthesis usually present? What with?
Adolescence- lower back pain, radiculopathy
What may be the appearance of a back with spondylolisthesis?
Flat due to muscle spasm
Some cases of spondylolisthesis may present acutely with what?
A characteristic waddling gait
How may minor degrees of slippage in spondylolisthesis be treated?
Rest and physiotherapy
How are severe cases of spondylolisthesis treated? What is the risk of this?
Surgical stabilisation and possibly reduction, risk of neurological injury
