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Pediatric Orthopedics > Pediatric Equinus > Flashcards

Pediatric Equinus Flashcards

1
Q

What is equinus

A

Limitation of the normal ankle joint dorsiflexion with the subtalar joint maintained in its neutral position

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2
Q

Normal ROM at birth

A

75 degrees of DG

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3
Q

Normal ROM at age 3

A

20-25 degrees DF

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4
Q

Normal ROM age 10

A

15 degrees FD

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5
Q

Normal ROM age 15 to adulthood

A

10 degrees DF

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6
Q

What happens to forefoot DF if the STJ is pronated

A

Pronated STJ allows the MTJ to be unlocked = excessive forefoot DF

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7
Q

What is a normal silfverskoid test

A
  • normal DF with knee extended
  • normal DF with knee flexed
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8
Q

What is pure Gastroc equinus

A

No DF with knee extended
Normal DF with the knee flexed

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9
Q

What is Gastroc-soleus equinus

A

No ankle DF with the knee bent and extended

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10
Q

.What is the most common form of equinus

A

Congenital Gastroc

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11
Q

What is Gastroc equinus

A

Limited DF with STJ neutral and knee fully extended

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12
Q

What is congenital soleus equinus

A

Limitation with the knee flexed

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13
Q

What is congenital Gastroc-soleus equinus

A
  • limitation with the knee flexed less than 10 degrees
  • sponges at end ROM when compared to boney equinus
  • WB stress lateral films to rule out boney block
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14
Q

What is spastic equinus

A
  • commonly associated with cerebral palsy, hyperkinesia
  • marked limitation in both knee extended and flexed
  • increased achillles reflex and ankle clonus
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15
Q

What is compensatory equinus

A

Excessive subtalar pronation causes shortening of gastric-soleus complex

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16
Q

What is ankle equinus (bone block equinus)

A

Abutment of the tibia on the talus

17
Q

What is athletic equinus

A

Anatomy driven; fibril increase in volume decreasing elasticity

18
Q

What is traditional equinus

A

Rapid growth without muscle components equally lengthening

19
Q

How does the body compensate for equinus

A
  • subtalar joint pronates
  • abduction of the foot to reduce need for ankle DF
  • early heel off
  • genu recurvatum
  • knee flexion during gait
20
Q

What happens during gait in compensated equinus

A
  • max pronation with calcaneal eversion
  • unrestricted STJ ROM without significant RF varus; allows the MTJ to unlock to allow for forefoot DF
  • rocker bottom at extreme, with long term repercussions
21
Q

Describe partially compensated equinus gait

A
  • low degree of STJ pronation and high degree of RF varus; MTJ cannot unlock, the gait abducts, early heel off, flexed knee during gait, genu recurvatum
22
Q

Describe the gait in uncompensated equinus

A
  • extreme muscle shortage with no heel contact
  • relatively rare and need to rule out idiopathic toe walking
23
Q

What happens during Gastroc-soleus complex equinus gait

A
  • tightness of the gastrocnemius muscle limits normal advancement of the tibia relative to the foot during the midstance phase of gait
  • for tibial advancement, when ankle joint dorsiflexion is limited, compensatory movements at joints proximal or distal to the ankle may occur, including the subtalar and midtarsal joints
24
Q

Equinus pathomechanics

A
  • Gastroc/soleus tightening
  • plantar aponeurosis tightening - related to STJ pronation, MTJ supination, 1st ray dorsiflexion
  • cavus foot - increased pressure at heel strike, increased Achilles tension
  • trauma - single or repetitive
  • obesity - overweight children have an increased prevalence of flatfoot
25
Q

Pediatric neurological roots

A
  • common in cerebral palsy
  • duchennes
  • Becker’s
26
Q

Describe idiopathic toe walking

A

Noted in children with cognitive delays
- vision evaluation
- botulinum treatment vs stretching

27
Q

What is calcaneal apophysitis/sever’s disease

A

Overuse syndrome thought to be auger by repetitive micro trauma due to increased traction of the calcaneo-Achilles apophysis

28
Q

What are the symptoms associated with calcaneal apophysitis/sever’s disease

A

Pain near lower posterior calcaneus close to Achilles attachment into secondary growth plate of the calcaneus

29
Q

What are some surgical options for equinus

A
  • Baumann Gastroc Recession - open release of the sheath
  • Edoscopic Gastroc Recesson - direct visualization with a scope
  • Tendo Achilles Lengthening - percutaneous vs. open; weakening
  • Advancement of the Achilles Tendon in Spastic Patients - Murphy procedure

Pediatric Orthopedics (18 decks)

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