Paediatric Foot, Ankle and Spine Problems

Question 1

What is the other name for Talipes Equinovarus?

Which joints are affected?

Answer 1

Club foot

Affects the joints between the talus, calcaneus and navicular bone

Question 2

What are some of the risk factors for developing talipes equinovarus?

Answer 2

Male

Breech delivery

Family history

Oligohydroamnios (low amniotic fluid)

Question 3

Talipes equinovarus - treatment (including special technique)

Answer 3

Early splintage - failure to do so can lead to fixed deformities

Ponseti’s technique is used to splint the foot, changing the cast every 5-6 weeks

After correction, the child’s feet are placed in a brace for 23 hours a day for 3 months, and through the night until 3/4 to prevent recurrence

Question 4

What is this condition?

How should it be treated?

Answer 4

Hallux valgus aka bunion

If occuring in childhood, corrective surgery could lead to recurrence

Treat with toe splint

Question 5

Back pain in children is (common/uncommon)

Answer 5

Uncommon - red flag!

Have a low threshold for referral

Question 6

What is spondylolisthesis?

At what vertebral level does it most commonly occur?

Answer 6

Slippage of one vertebra over another

Usually occurs at the level of L4/L5 or L5/S1

Question 7

Spondylolisthesis - presentation

Answer 7

Low back pain

Paradoxical flat back due to muscle spasm

Classical waddling gait

Radiculopathy if the slippage is severe (compression of nerve roots resulting in tingling, pain or loss of function)