Lecture 11-14 Flashcards
At 7 weeks gestation what happens to the limbs
Upper limb bud rotates external
lower bud rotates int
(femurs ext, tibias int)
-Torsional deformities arise when these processes are arrested or accentuated
overall diagnostic approach to examining lower limb
- Evaluate for foot deformity
- evaluate gait and coordination
- evaluate lower limb oath
- Evaluate for rotational profile
- Evaluate angular profile
- Incidental issues
a fallen arch is normal up to what age
10yold`
flexible fallen longitudinal arch is made up of what
Talus rot medially
calcareous rotated outwards
What are common foot conditions leading to intoning
Metatarsus Adductus
Bilateral Metatarsus Adductusq
What is metatarsus adductus
Adduction and inversion of the metatarsal bones resulting in in toeing
(normally line drawn thru heel should intersect the second/third toe space of the foot)
What is bilateral metatarsus adductus
Medial deviation of the forefoot, rounded lateral foot border
Pathology of toein
Tarsometatarsal jts subluxate medially
adduction and inversion of all 5 metatarsals
-hindfoot in neutral or valgus
What is the v finger test and what does it mean
The lateral aspect of the foot is observed from a plantar side for medial or lateral deviation from middle finger
-medial deviation from the middle finger at the styloid process indicateds MTA
incidence of toe lining and associated risk factors
1/500
Congenital dislocation of hips in 2-10% of cases
What is metatarsus virus
A fixed deformity caused by in utero subluxation
does NOT correct spontaneously after birth
What is calcaneovalgus foot and how does it look
the forefoot is abducted and the ankle is dorsiflexed (up and out appearance)
(seen in 30%, 1/1000 severe)
What is searching toe and why does it happen
Big toe points medially during gait
contracture of abductors during stance
What is club foot And what is it associated w
forefoot varus, heel varus, ankle equines
associated w CP, polio, neuromm disease
Tx for club foot (2)
Stretching/casting
Ponseti method- seriel casting
French method- taping and stretching
also surgery
If you see tip toe gait after 2 years what could it indicae
idiopathic toe walking
Neuro (CP, spinal dysgraphia, myopathy, neuropathy)
if u see out toeing what could it mean
External femoral tosion
External tibial torsion
IF you see in toeing what could it mean (3)
Metatarsus adductus
medial tibial torsion
internal femoral torsion
What is medial tibial torsion associated q
COngenital metatarsus adductus
Genu valgum
femoral anteversion
Torsion is diagnosed if
The rotation is >2 standard deviations from the mean
how to measure rotational profile according to staheli
- foot progession angle
- Int rot of the hip
- Ext rot of the hip
- Thigh foot angle
- Transmalleolar angle
Other ways to evaluate tibial torsion
Malleolar palpation (if at the same lvl then 20-30degrees int rot, normal is lat post)
Internal tibial torsion management
spontaneous resolution in 95% of children by 8
stretching
moderate/fixed should be surgical
causes of external tibial rot
Extremely rare
- -sleeping prone with the legs externaly rot
- my be secondary to femoral antevertion or IT band contracture
Symptoms of femoral antiversion
In toeing of gait bilaterally, clumsiness, cosmetic cancer, sitting in W pos
What is the craigs test for femoral ante version
pt prone and int rot hip
Degree of rot at which trochanter is most prominent (degree of femoral anteversion)
most accurate imaging method to see ante version
CT
tx of ante version
Usually corrects by 8
notable hip conditions in children
Congenital hip dysplasia
Transient hip synovitis
SCFE
Legg Calve PErthes
Angular changes of knees in 0-2. 3-4, 5-7, adult
0-2– bow legs
3-4– Knock knees
5-7– straight
adult- slight knock
lower limb growing pains featrues
-no evidence they are truly related to growth
- age 3-12
- normal growth
- leg pain, worse at night, poorly localized
- pain in mm not joints
- absense of jt pain, limp, disability, inflammation
What things should u check for the brighten score
- Palms on ground 1 pt
- each knee that bends back 1 pt
- each elbow that bends back 1pt
- thumb that touches forearm 1pt
- 5th digit bend back >90 1 pt
benign paroxysmal torticolis signs/characteristics
- attacks that last hours to days (but < 1w)
- reoccurs every few days to every few m
- Imprves over 2 years, ends by 3
- fam hx of migraine
- severe GERD
What is craniosynososis and what does it cause
early closure of suture of the skull (normally close aroundd 12-18m)
infants have
- Increased intracranial pressure
- vision hearing and breathing problems
- head shaped like a trapezoid
- ear pos post
What is neurogenic torticollis
An acute episode of torticollis that usually occurs in older children w neuro annomolies
what is osseous torticollis and what is it caused by
congenital cervical spine malformations (klippel-feil)
-passive ROM limited (without tightness/thickening of SCM)
What is KISS/KIDD
biedermann proposed that birth trauma induced upper cervical dysfunction has immediate consequences (KISS) and if left untx could lead to KIDD
Acquired postural torticolis features
SCM tightness and thickening
no palpable mass
COngenital mm torticolis features
w or w/o SCM tumor
palpable mass in SCM
often seen w breech presentations and difficult deliveries
what side are most congenital mm torticolis
75% on R
What is congenital torticolis
mm damage during labor
observe/palpate mm lump
