PEDIATRIC FLAT FOOT

Question 1

which is true about pediatric flatfoot?

pediatric flatfoot like adult flatfoot usually a collection of causes*** a t/f question

can be a combination of congenital, structural, soft tissue and gestational position contributing to the flatfoot

pediatric flatfoot generally more responsive to tx than adult flatfoot

Answer 1

all the above

Question 2

what must you observe in order to characterize a flatfoot?

Answer 2

everted calcaneus

abduction of the forefoot on the rearfoot, too many toes sign

collapse of the medial column

Question 3

what is important to differentiate among flatfoots? (1st we must always do)

Answer 3

flexible flatfoot from rigid flatfoot
-rigid flatfoot will not exhibit STJ ROM, this is how we tell between flexible from rigid flatfoot

*pediatric more often flexible

Question 4

in weight bearing what position is the STJ in?

Answer 4

STJ is maximally pronated, this allows the MTJ to increase its range of motion because the axis at each joint becomes more parallel to each other and as the forefoot becomes weight bearing the MTJ is unable to stabilize the pronators forces of the ground reactive forces. Normal osseous stability is lost

Question 5

when will the pediatric patient have the foot they have as an adult?

Answer 5

9 years old

Question 6

this type of equinus must be differentiated from cause of equinus?

which one is most common in pediatric patient? not common?

Answer 6

compensated equinus

congenital; acquired

Question 7

this is an accessory ossicle that causes flatfoot? how so?

Answer 7

Os tibiale externum; PT insertion into the ossicle decreases the mech advantage of the PT

Question 8

what is this flexible flatfoot?

intrauterine position

at birth, entire foot is dorsiflexed and everted relative to the leg

can actually touch the anterior tibia with the forefoot

foot shows a convex medial border and concave lateral border

deformity is flexible and spontaneously reduces with age

distinguish from vertical talus

Answer 8

congenital talipes calcaneovalgus

Question 9

what is true about congenital vertical talus?

multifactoral

deformity is rigid

calcaneus is rotated into equinus

forefoot is dorsiflexed and abducted on the rearfoot

contracture of the triceps surae, dorsal ligamentous structures and dorsal tendons

Answer 9

all the above

Question 10

best view of for congenital vertical talus?

Answer 10

best view is a stress plantarflexion lateral

-prognosis poor without surgery

Question 11

this is a flexible flatfoot deformity in which the metatarsals are medially deviated on the lesser tarsus

most likely genetic and acquired factors

presents as flexible, semirigid or rigid

*as opposed to a forefoot adductus in which the lesser tarsus is also adducted relative to the rearfoot

Answer 11

metatarsus adductus

Question 12

for metatarsus adductus a flexible flatfoot deformity, what is the angle at 18 months?

Answer 12

20 degrees, so bisection of 2nd metatarsal relative to a line traversing 1st and 4th met bases exceeds 25 degrees at birth, 20 degrees at 18 months, 10 degrees at adulthood

Question 13

kids easier to treat conservatively, T/F?

Answer 13

true

Question 14

what is this torsional cause:

leg internally rotated at the hip joint

internal position results in adducted patella and in toe position to the feet

resulting intoe directions to foot typically requires STJ pronation to compensate

Answer 14

hip anteverison

Question 15

what is this torsional cause?

leg externally rotated at the hip

if over rotation occurs, abducted patella results and out toe effect on the foot

foot externally rotated. center of gravity directed more medially to the STJ axis

Answer 15

hip retroversion

Question 16

whats internal tibial torsion?

Answer 16

normal valve is 0-5 external at birth, 18-23 degree external at adulthood

evaluated by malleolar position which is indirect due to fibula involved in the process

compensation occurs when patient can pronate at the STJ and abducting the foot

Question 17

this is known as knock knees and this is when the knee is in valgus position, tibia everted in the frontal plane

physiologic genuflects valgum present between ages 3-5, gradually reducing by 8 yrs of age

Answer 17

genu valgum

Question 18

common etiology of rigid flatfoot:

most common will be tarsal coalition with or without peroneal spasm, which one is most common. which one is most identifiable?

Answer 18

TC

CN

Question 19

this is a medial flange to add surface area to the medial arch and enhance orthotic control?

Answer 19

Shaffer modification

in management, the device should eliminate STJ motion

Question 20

surgical management for pediatric flatfoot?

Answer 20

STJ arthroresis

achilles tendon lengthening

kidner procedure