Foot, Ankle and Spine Conditions

Question 1

Talipes equinovarus is also known as what?

Answer 1

Clubfoot

Question 2

Is it common for clubfoot to be bilateral?

Answer 2

50% of cases

Question 3

What happens in utero to cause clubfoot?

Answer 3

Abnormal alignment of the talus, calcaneus and navicular bones

Question 4

The abnormal development in clubfoot causes contractures of the soft tissues which results in what deformities?

Answer 4

Ankle plantar flexion (equinus), forefoot supination and varus

Question 5

Which sex is clubfoot more common in?

Answer 5

Boys

Question 6

Apart from male sex, what are some other risk factors for clubfoot?

Answer 6

Family history, breech position, oligohydramnios, skeletal dysplasia

Question 7

What condition should all babies with clubfoot be screened for at birth?

Answer 7

DDH (ultrasound)

Question 8

What treatment is used for clubfoot? What are the outcomes of this?

Answer 8

Ponseti technique (splintage), asap after birth. 90% of cases are successful.

Question 9

What are the 2 steps of the Ponseti technique?

Answer 9

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

Question 10

When do cases of clubfoot require surgery?

Answer 10

If recurrent or a delayed presentation

Question 11

What can occur in delayed cases of clubfoot?

Answer 11

Fixed deformities with the child walking on the outside of their foot

Question 12

What are the outcomes of delayed presentations of clubfoot?

Answer 12

Difficult to correct and extensive surgery with poor results

Question 13

To maintain full correction, most cases of clubfoot require what operation?

Answer 13

Achilles tendon tenotomy

Question 14

What happens in tarsal coalition?

Answer 14

There is an abnormal bridge between the calcaneus and navicular, or the talus and calcaneus

Question 15

What can tarsal coalition lead to?

Answer 15

Painful fixed flat feet in older children

Question 16

What treatment can be used for tarsal coalition?

Answer 16

Splintage/orthotics, but if the pain is resistant then may need surgery

Question 17

When can hallux valgus appear in younger people? What is it associated with?

Answer 17

In late adolescence, normally has a strong family history

Question 18

What is the problem with surgical correction for hallux valgus in adolescents?

Answer 18

There is a high risk of recurrence and deformities later in life

Question 19

What is the likelihood that back pain in adolescents and children is serious?

Answer 19

It is always a red flag so worth getting checked out

Question 20

What are some causes for scoliosis?

Answer 20

Idiopathic (most common), tumours, neuromuscular disease, skeletal dysplasia, infection

Question 21

Idiopathic scoliosis is most common in who?

Answer 21

Females, usually presenting with concerns regarding appearance

Question 22

Scoliosis which has an underlying cause usually occurs in who?

Answer 22

Younger children

Question 23

Any scoliosis which is painful warrants what?

Answer 23

MRI for tumour/infection

Question 24

Do all cases of scoliosis require surgery?

Answer 24

No, only larger curves with cosmetic problems or to improve wheelchair posture

Question 25

Severe cases of scoliosis can result in what?

Answer 25

A restrictive lung defect- surgery is required to prevent breathing difficulties

Question 26

What does surgery for scoliosis involve?

Answer 26

Vertebral fusions and long rods connecting the posterior elements of the spine

Question 27

Correction of large deformities in scoliosis has a risk of what?

Answer 27

Spinal cord injury

Question 28

What is spondylolisthesis?

Answer 28

The slippage of one vertebra over another

Question 29

Where is spondylolisthesis most common?

Answer 29

L4/5 or L5/S1 levels

Question 30

What can cause spondylolisthesis?

Answer 30

A developmental defect or a recurrent stress fracture which fails to heal

Question 31

When does spondylolisthesis usually present? What with?

Answer 31

Adolescence- lower back pain, radiculopathy

Question 32

What may be the appearance of a back with spondylolisthesis?

Answer 32

Flat due to muscle spasm

Question 33

Some cases of spondylolisthesis may present acutely with what?

Answer 33

A characteristic waddling gait

Question 34

How may minor degrees of slippage in spondylolisthesis be treated?

Answer 34

Rest and physiotherapy

Question 35

How are severe cases of spondylolisthesis treated? What is the risk of this?

Answer 35

Surgical stabilisation and possibly reduction, risk of neurological injury