paeds- foot & ankle

Question 1

Talipes Equinovarus (Clubfoot)

Answer 1

congenital deformity of the foot affecting 1 in 800 births and is due to in utero abnormal alignment of the joints between the talus, calcaneus and navicular.

Around 50% of cases are bilateral.

The abnormal alignment of these joints results in contractures of the soft tissues (ligaments, capsule & tendons) resulting in a deformity consisting of ankle equinus (plantarflexion), supination of the forefoot and varus alignment of the forefoot which are not immediately correctable.

Question 2

clubfoot risk factors

Answer 2

Boys are twice as commonly affected than girls, there may be a genetic link with a positive family history and it is more common in breech presentation

Oligohydramnios (low amniotic fluid content) is another risk factor and it is occasionally part of another skeletal dysplasia.

Question 3

clubfoot treatment early

Answer 3

treatable with early splintage and diagnosis is usually obvious however delayed presentations (uncommon in modern healthcare systems) can result in fixed deformity with the child walking on the outside of their foot.

Question 4

club foot treatment late

Answer 4

Late deformity is very difficult to correct and requires extensive surgery (soft tissue +/‐ bony procedures) with less satisfactory results.

Surgery may also be required for cases resistant to splintage.

Question 5

clubfoot- Ponseti technique

Answer 5

splintage technique, commenced as soon as possible after birth and the deformities are corrected progressively in stages and held in plaster casts with 5 or 6 weekly cast changes. 80% of children require a tenotomy of the Achilles tendon (a minor procedure) to maintain full correction.

Once full correction is achieved the child is then placed in a brace consisting of boots attached to a bar which is worn 23 hours a day for 3 months and used during sleep until the age of 3 to 4 to try to prevent recurrence.

Question 6

Tarsal Coalition

Answer 6

This is a condition where there is an abnormal bridge (bony, fibrous or cartilaginous) between the calcaneus and navicular or between the talus and calcaneus.

It can lead to a painful fixed flat foot deformity in older children.

Symptoms may improve with splintage / orthotics whilst resistant pain may require surgery to remove the abnormal connection.

Question 7

Hallux valgus

Answer 7

can occur in late adolescence and usually has a strong family history.

Surgical correction in this age group carries a risk of recurrence of the deformity later in life.