Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal System > Pediatric Feet > Flashcards

Pediatric Feet Flashcards

1
Q

Normal foot

A

plantar grade
“neutral” hindfoot
plum line should intersect with the posterior border
medial and lateral borders of the foot are straight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tripod

A

Foot acts as a tripod - lateral, medial, and posterior rays- with weight bearing spread across the calcaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hx of foot deformity

A

CC
Hx of CC - pain, deformity?
what is the issue of deformity?

Think: is it a problem with abnormal walk?
was it something gradual (onset) or acute?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gradual onset

A

DDx: spinal dysraphism
neuromuscular disease
congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute onset

A 
DDx: trauma 
fx
abuse 
strain
sprain 
infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PE of the foot

A

watch them walk !!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are you looking for in a PE

A

-muscle atrophy- asymmetry
-swelling – affected or distant area
-deformity, rotational position – what normals are for rotation ?
-angular position
-hindfoot position
Active range of motion – need to know normal
Passive range of motion
Muscle testing- muscle strength
Neurologic exam
-Patellar &Achilles deep tendon reflexes
-Babinski test (UMN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infant benign foot deformities

A

Congenital

  • simple polydactyly
  • simple syndactyly
  • metatarsus varus (adductus)
  • calcaneovalgus
  • congenital curled toe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Infant pathologic foot deformities

A

Congenital

  • complex polydactyly
  • complete and/or complex syndactyly
  • club foot
  • vertical talus
  • cleft foot
  • macrodactyly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Polydactyly

A

congenital foot deformity
often an isolated trait
small nubbin on lateral border of the foot (post axial)

extra bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Preaxial polydactyly

A

either thumbs for upper extremities or big toes for lower extremities have nubbin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Postaxial polydactyly

A

little finger or toe has nubbin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a nubbin?

A

collection of tissue with artery and vein
Tie off the nubbin => will turn dry gangrene and fall off few days to wks

may have nail => indicate little bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Goal of tx of polydactyly

A

be able to wear shoes comfortably
-> need to surgically remove
surgically remove to insure comfortable shoe wear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Syndactyly

A

failure of programmed cell death- sporadic cases are 80%

mesenchymal limb bud -> AER -> signaling of cell death defective -> webbing of the fingers (skins only)

Usually occurs between 3rd/4th toes
occurs bilaterally/symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Variations of syndactyly

A

Complete
Incomplete
Simple
Complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complex syndactyly

A

webbing the entire length of the digit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Incomplete syndactyly

A

webbing partial length of digit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Simple syndactyly

A

soft tissue union

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Complex syndactyly

A

bony union

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Surgery indications for syndactyly

A

FOR THE FEET, ONLY DO SURGERY if SHOE WEAR IS DIFFICULT

THETHERING DEFORMITY ON THE FINGERS DUE TO SYNDACTYLY – NEED SURGERY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Etiology of the Packaging defects

A

First pregnancy
Multiple gestation
large baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Packaging defect

A

plegiocephaly - head misshapen
frontal bone is more prominent than another side
eyes and ears are asymmetric

metatarsus varus
calcaneovalgus
clubfoot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Metatarsus varus (adductus)***

A

result of packing defect

Mild>moderate = medial border of the foot curves inward 
severe = medial border of foot curves inward and it's stiff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mild/moderate vs severe metatarus varus

A 
Mild/moderate = flexible
severe = stiff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PE metatarus varus

A

ALWAYS CHECK THE HIPS

gentle manipulation of foot with diaper changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Tx metatarus varus

A

start putting them on shoes
corrective shoes - straight last , reverse last, be back shoes

rarely require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When will a reverse shoe not be tolerated

A

severe metatarsus varus because they are not flexible

will have skin problems if given reverse shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Calcaneovalgus

A

packing defect
benign non position foot
flexible foot position corrects with gentle manipulation
foot is dorsiflexed to the tibias anterior
DDx : vertical talus or fibular hemimelia
PE: always check the hips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Serial casting

A

can be used to tx metatarsi varus -refer to orthopedic surgeon

rarely needed for calcaneovalgus
Doesn’t work for vertical talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Calcaneovalgus present with hip dysplasia

A

unilateral CV

foot splay?

32
Q

Congenital curled toe**

A

-result from contracture
-presentation: standing on the lateral aspect of the little toe
-shoe wear is a problem
do surgery but it is of high risk

33
Q

Clubfoot *

A
  • Idiopathic : unknown
  • a packaging defect
  • arthrogryposis - resistant = foot doesn’t respond well
  • myelodysplasia - marrow dysplasia
  • hereditary

ABNORMAL MESENCHYMAL TISSUE IN THE MEDIAL BORDER

34
Q

Associated problem with clubfoot

A

spinal dysphargism = particularly if the foot is bent unilaterally

35
Q

Tx of clubfoot

A

nonoperative - need two different shoe sizes
infants - stretch, cast to correct the talocalcaneal joint => ensure that aspiration is resolved

wait until children is 5-6 mon to a year to do a surgery

talus and subtalus and talus/navicular joints need to be open

36
Q

Dx of clubfoot

A

check hips for dysplasia or instability

check spine for sacral clefts, dimples, hairy patches

37
Q

Presentation of clubfoot

A

pt stands on dorsolateral of the foot
development of the leg affected is thinner
limb on the affected side is always smaller

38
Q

Sx of clubfoot

A 
posterior crease 
medial crease 
empty heel pad 
adducts of forefoot varus of hind foot 
supination mid/forefoot
39
Q

Differentiate b/n clubfoot and metatarsus !!!

A

Posterior crease is deep
medial crease - only soft tissue = calcareous is not at the anatomical position
hind foot is varus (point inward)
mid foot and forefoot are supinated

40
Q

Vertical talus **

A

Rockerbottom foot - > rigid foot = can’t plantar flex = AKA RIGID HINDFOOT VALGUS

This is a pathologic condition

41
Q

DX vertical talus

A

palpate the head of the talus through the skin

42
Q

Presentation of vertical talus

A

weight bearing on the head of the talus

43
Q

Tx of vertical talus

A

-cant reduce mid foot and talus

refer to orthopedic surgeon to restore tripod

44
Q

Macrodactyly

A

pathologic = overgrowth syndrome

gigantism of bones, muscles, nerves (4x size), vasculature

population: seen in AMISH people

45
Q

Tx of macrodactyly

A

refer to ortho surgeon

goal is to wear comfortable shoes

46
Q

Cleft foot***

A

central failure of formation

can happen in hand and feet

47
Q

Acquired foot deformity

A
  1. Pes planus - flat feet
    - flexible
    - rigid: tarsal coalition
  2. Cavus - serious pathological condition - need to know Ddx
    * **cavovarus
48
Q

Presentation of a child with flat foot

A

the medial side is not well balanced

bottom of the foot is blanched

49
Q

longitudinal foot in a toodler

A

NORMAL

less than 2 y/o

50
Q

A 2 y/o has a longitudinal arch

A

DDx : spinal dysphyragism

congenital spinal and neuromuscular diseases

51
Q

Pes Planus

A

BENIGN
rarely symptomatic
subluxation of the talonavicular joint***

  • *flattened longitudinal arch
  • mild
  • moderate
  • severe
  • *hindfoot valgus
  • *Flexible
  • *Rigid
52
Q

presentation of per planus

A

walking on the talus
acquired vertical talus
flexible - assoc. with ligamentous laxity

53
Q

Flexible pes planus***

A

DDx
ligamentous laxity
tight tendoachilles
overcorrected clubfoot
fibular longitudinal deficiency - absence of the fibula (no lateral strut of the fibula)
=> this can clue in on leg length deficiency and it is a congenital problem!

54
Q

Test for flexible flat feet

A

how can you tell flexibility? stand on toes

arched support may be needed but RARE

55
Q

Hind foot valgus - Pes planus

A

subtalar instability

ankle instability

56
Q

Notes on hind foot valgus - per plans

A

LOW GRADE SPINAL BIFIDA

FIBULA IS ATROPHIC – INDICATION OF PARTIAL PARALYSIS
GROWTH PLATE
FIBULA DID NOT GROW AS WELL
DISTAL TIBIA SHOULD BE PARALLEL WITH THE TALUS BUT ITS NOT
TWO SCREWS ARE PUT IN – THEN , MEDIAL ASPECT OPENS UP
TETHER THE SIDE THAT IS GROWING !

57
Q

Rigid pes planus

A

Tarsal coalitions - fibrous, cartilagenous, boney
nonpainful
painful - refer to ortho

58
Q

Tarsal coalitions

A

an abnormal connection that develops between two bones in the back of the foot (the tarsal bones)

50% -60 % of coalitions are bilateral
Peroneal spasm!!!!!

59
Q

Synostosis tarsal coalition

A

boney coalition

60
Q

synchondrosis tarsal coalition

A

cartilagious coalition

61
Q

syndesmosis tarsal coalition

A

fibrous coalition

62
Q

Sites of tarsal coalitions

A

**Calcaneonavicular - begins to ossify @ 8-14 yrs.
**Talocalcaneal - begins to ossify 12 yrs to adult
**Calcanealcuboid
Talonavicular
Navicularcuboid
Navicularcunieform

63
Q

Accessory navicular

A

Pes planus

TIBILARIS POSTERIOR INSERTS at the point in navicular
CAN TEST THIS BY HAVING PATIETNT ABDUCT FOOT AND TRY TO ADDUCT IT AGAINST RESISTANCE

64
Q

Cavus/cavovarus***

A

Genetic
Increased height of longitudinal arch
Hindfoot varus-ALL WEIGHT BEARING ON THE LATERAL SIDE
Claw Toes
Deformities may be flexible or fixed
MUSCLE IMBALANCE FROM SENSORY/MOTOR NEUROPATHY
MIDDLE CREASE

65
Q

Tx goal for cavus

A

RESTORE PLANTAR GRADE
BEST THEM TO GO TO A NEUROLOGIST
PCP WILL DO THAT

66
Q

underlying causes of cavus (conditions are PROGRESSIVE AND DEGENERATIVE)

A 
Charcot-Maire Tooth Disease
Spinocerebellar Degenerations
Myelodysplasia
Polio
Spastic Monoplegia or Dyplegia
Polyneuritis
Myopathy       
 Trauma
Spinal Cord Tumor
Occult Spinal Dysraphism
Arthrogryposis
Congenital Lymphedema
Congenital Syphilis  
Residual Clubfoot Deformity
67
Q

Workup for Cavus

A 
Detailed history 
Prenatal 
Perinatal	
Developmental history
Family  Medical History
Onset of deformity (congenital, gradual,rapid)- SORT OUT DDX 
Functional Status***ESP FOR OLDER PTS
68
Q

PE of Cavus

A 
WATCH THEM WALK 
Examine  Gait
Muscle Strength Testing
Reflexes Upper and Lower Extremities
Muscle Tone & testing for strength
Clonus-INVOLUNTARY MUSCLE CONTRACTION
Babinski  Sign
Superficial Abdominal Reflex
SUBTLE WEAKNESS OF TIB ANTERIOR 
COMPENSATING 
Meticulous Examination of the Spine
Skin 
Posterior & Sagital  views
Palpate for defects- SPINA BIFIDA CAN BE A DDX
69
Q

Referral of Cavus

A 
Neurology      
EMG & Nerve Conduction Studies  
MRI (head &/or spine)
Muscle  &/or Nerve Biopsy	
Genetics
DNA Testing
70
Q

Lab tests for Cavus

A

CBC with Diff
Urinalysis
CPK prn

71
Q

XR measurement of Cavus

A

** LINES SHOW CAVUS

1ST LINE – FIRST RAY (TOP PIC)

72
Q

Kelikian’s “Push-up” Test

A

Test for Cavus

TOES CLAWED NO MATTER WHAT HAPPENS TO METATARSAL HEADS

73
Q

Non surgical Tx of Cavus

A

Stretching contracted plantar fascia
Insoles for painful flexed metatarsal heads
Shoes , Braces & Orthotics DO NOT correct or prevent deformity- NOT USEFUL – COSTLY
Orthotics in flexible deformity
AFO with dorsiflex assist

74
Q

Goal tx of caves

A

MAINTAIN AND PROMOTE FUNCTION WITHOUT SHOE WEAR PROBLEMS

75
Q

Goal tx of caves

A

MAINTAIN AND PROMOTE FUNCTION WITHOUT SHOE WEAR PROBLEMS

Musculoskeletal System (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions