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Pediatric Orthopedics > Metatarsus Adductus > Flashcards

Metatarsus Adductus Flashcards

1
Q

What is met adductus

A

Uniplanar deformity
Position or structural transverse plane deformity of the metatarsals at the tarsometatarsal (LisFranc’s) joint level

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2
Q

What is the most significant angular relationship in the diagnosis of the metatarsus adductus

A

Metatarsals adductus

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3
Q

‘What are some clinical findings of met adductus

A

C-shaped foot - convex lateral border, concave medial border, apparent high arch
Prominent 5th MT tuberosity
Abduction of MT 1-5 in transverse plane
Possible FF varus
May see separation of great toe
Heel-forefoot bisection is not parallel
Lack of abduction past midline
Muscle (TA) hyperactivity

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4
Q

What is the most common form of met adductus

A

Milf to moderate

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5
Q

What is the appearance of compensated juvenile Met adductus

A

Rearfoot is pronated
Develop a collapsing flexible pes planovalgus
Not a true MA
Positional deformity

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6
Q

What does compensated adult met adductus look like

A

Skewfoot
Z-foot
Serpentine foot
Juvenile bunions
Flexor stabilization hammertoes
Tailors bunion
Splay foot

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7
Q

What does uncompensated met adductus look like

A

Cavus foot type aka cave adductovarus
Rigid forefoot valgus - tripod effect, rigid forefoot valgus
Extensor substitution hammertoes - dynamic swing phase induced hammertoes

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8
Q

When do you see extensor substitution hammertoes vs flexor stabilization hammertoes in metadducts

A

Extensor substitution in uncompensated met adductus
Flexor stabilization in compensated adult

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9
Q

What is the met adductus angle

A

Lesser tarsus axis with bisection of 2nd MT axis

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10
Q

What is a normal met adductus angle

A

15 degrees

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11
Q

What is a mild met adductus angle

A

15 -20 degrees

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12
Q

What is a moderate met adductus angle

A

21-25 degrees

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13
Q

What is a severe met adductus angle

A

Greater than 25 degrees

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14
Q

`

A
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15
Q

Describe the MA angle on DP view

A

Increased (>15 degrees)

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16
Q

Describe the 2nd metatarsal cuneiform angle on DP view in MA pts

A

Increased (greater than 24 degrees)

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17
Q

Describe the talar axis on DP view in MA pt

A

Medial deviation

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18
Q

Describe the cyma line on DP view in MA pt

A

Anterior break in cyma line

19
Q

Describe kite’s angle on DP view in MA pts

A

Increased

20
Q

Describe the calcaneal inclination angle on lateral view in MA pt?

A

Decreased

21
Q

Describe the talar declination angle on lateral view in MA patient

A

Decreased

22
Q

Describe cyma line on lateral view in MA pts

A

Posterior break

23
Q

Describe MA on radiograph using navicular and kite;s angle

A

Navicular lateral
Increased kite’s angle

24
Q

Describe clubfoot on radiograph using navicular and kites angle

A

Navicular medial
Decreased kite’s angle (< 15 degrees)

25
Q

When is surgical correction of MA advocated for in peds pt?

A

After 2 years, following unsuccessful results with conservative treatment

26
Q

What is one soft tissue ligamentous release performed for peds for MA

A

Hey man Herndon Strong (HHS)
2-5 years

27
Q

When are osseous procedures typically performed for peds pt with MA

A

Greater than 6 years - to evaluate growth plate

28
Q

Describe the Heyman, Herndon and Strong procedure

A

Complete mobilization of tarsometatarsal and intermetatarsal ligaments

29
Q

Heyman Herndon & Strong procedures is a/an _______ caspulotomy

A

Anterior

30
Q

Which ligaments must be preserved in Heyman, Herndon & Strong procedure

A

Plantar-lateral ligaments

31
Q

What fixation is used for Heyman, Herndon & Strong procedure

A

K wire fixation

32
Q

What is the post op course for Heyman, Herndon & Strong procedure

A

Cast immobilization for 3 months

33
Q

Describe the Johnson wedge chodrotomies for MA

A

Age - 6-8
Closing base wedge osteotomy of 1st MT
Take out cartilage of bases 2-5

34
Q

Describe the McCormick and Blount osteotomy of MA peds pt

A
  • recommended after skeletal maturity
    1st metatarsal cuneiform arthrodesis
    Closing wedge resection out of cuboid
    Lateral wedge osteotomied of bases of MT 2-4
35
Q

Describe Fowler procedure for MA peds pt

A
  • opening wedge on medial cuneiform with insertion of bone graft
  • Used for transverse plane correction
  • performed on pts greater than 12 yrs old
36
Q

Describe steyler and van der Walt osteotomy on MA peds pt

A
  • V-shaped osteotomies
  • wedge osteotomies of all the metatarsal bases
  • osteotomies were not fixated
  • felt osteotomies were more stable and would prevent inadvertent displacement of the distal fragment
37
Q

Describe Berman and Gartland osteotomy for peds MA pt

A

Crescent or dome shaped osteotomies of all metatarsal bases
May fix only 1st, 5th and 3rd metatarsal osteotomies ( vassal principle)

38
Q

Describe lepird procedure for peds MA pt

A
  • oblique closing wedge osteotomies of 1st and 5th MT bases
  • MT rotational osteotomied of 2nd, 3rd and 5th MTS
  • central 3 MTs performed in transverse plane
39
Q

Describe grumbling procedure for peds MA pt

A

Opening wedge on medial cuneiform with cuboid decancellation

40
Q

Recommendation for 0-2 yr old MA pt

A

Soft tissue manipulations, stretching, exercise, serial casting

41
Q

recommendation for 2-5 yo MA pt

A

HHS procedure

42
Q

Recommendation of 6-8 yo MA pt

A

Johnson wedge chondrotomy

43
Q

Recommendation for MA pt greater than 8

A

Various other procedures
Leprid, Fowler etc

Pediatric Orthopedics (18 decks)

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