Paediatric Foot, Ankle and Spinal Problems Flashcards
By what other name is clubfoot known?
Talipes equinovarus
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What is talipes equinovarus?
A congenital deformity of the foot caused due to inutero abnormal alignment of the jonts between the talus, calcaneus and navicular leading to soft tissue contractures
What are the 3 main deformities in talipes equinovarus?
- Ankle equinus (plantarflexion)
- Supination of the forefoot
- Varus alignment of the forefoot
Which sex is more commonly affected by talipes equinovarus?
Boys
What are the main risk factors for talipes equinovarus?
- Male gender
- Family history
- Breech births
- Oligohydramnios (low amniotic fluid content)
- Another coexistant skeletal dysplasia
Which technique can be used to treat babies as soon as possible after birth?
Ponseti technique
What does the Ponseti technique involve?
- Deformities are corrected progressively by being held in evolving plaster casts with 5 or 6 weekly cast changes.
- 80% of children require a tenotomy of the Achilles tendon
- The child is placed in a brace when full correction is achieved
- This brace is worn 23 hours a day for 3 months and then solely during sleep until the age of 3-4 to prevent recurrence
How are delayed presentations of talipes equinovarus treated?
Extensive surgery involving bony and soft tissue procedures
What is tarsal coalition?
When there is an abnormal bridge between the calcaneus and navicular or talus and calcaneus
This bridge can be bony, fibrous or cartilaginous
What may tarsal coalition lead to in older children?
Painful fixed flat foot deformity
How can symtpoms be improved for tarsal coalition?
Splintage/orthotics
(resistant pain may require surgery to remove the abnormal connection)
When does hallux valgus usually present in terms of paediatrics?
Late adolescence
Hallux valgus usually has a _______ family history
Strong
What is the problem with surgical correction of hallux valgus in the adolescent age group?
This carries a risk of recurrence
Back pain in children is a red flag, what 3 main things may it signify?
- Infections (discitis)
- Tumours (such as osteoid osteoma)
- Spondylolisthesis