Pediatric Flatfoot

Question 1

Is the flatfoot pain usually better / worse with WB?

Answer 1

worse with WB

Question 2

if pain is NWB, what other causes might you consider?

Answer 2

infection, arthridity, tumor

Question 3

what is a skewfoot?

Answer 3

pronated rearfoot with adductovarus forefoot

Question 4

what would you expect on a heel rise test if you had a flexible flatfoot?

Answer 4

heel would invert on heel rise

Question 5

True of false: a young child with a cavus foot is MORE alarming than a flatfoot.

Answer 5

true

Question 6

children have a pronated foot during development. this is normal until waht age?

Answer 6

7-8 y/o

Question 7

what is the total ROM for a child? how much inversion? eversion?

Answer 7

total: 50-60 deg
inversion- 35-50 deg
eversion: 15-20 deg

Question 8

what is the total ROM for an adult? how much inversion? eversion?

Answer 8

total: 25-35 deg
inversion- 20 deg
eversion- 10 deg

Question 9

for a child that is 6y/o what is the normal maximum RCSP?

Answer 9

2 deg valgus
*calculate using:
8- (age of child)= max. RCSP
*use this equation for

Question 10

what is considered a mild RCSP in children >7 y/o?

Answer 10

2-5 valgus

Question 11

what si considered moderate RCSP in children > 7 y/o?

Answer 11

6-10 valgus

Question 12

what is considered severe RCSP in children > 7 y/o?

Answer 12

> 10 valgus

Question 13

What is Ryder’s test used to determine?

Answer 13

if there is excessive internal rotation of the hip

Question 14

what is Ryder’s test?

Answer 14

place greater trochanter in frontal plane, and femoral condyles should be in line

Question 15

what are the biomechanical causes of flexible flatfoot?

Answer 15

1. excessive internal rotation of the hip
2. excessive internal knee rotation
3. internal tibial rotation

Question 16

any type of excessive internal rotation causes what?

Answer 16

CKC pronation

= calcaneal eversion; talar plantarflexion and adduction; and tibial internal rotation

Question 17

what are some causes of adducted gait?

Answer 17

1. internal tibial torsion
2. femoral anteversion
3. tight medial hamstrings
4. pigeon-toed deformity

Question 18

what are some causes of abducted gait?

Answer 18

1. met abductus
2. forefoot abductus
3. external malleolar torsion
4. external tibial torsion
5. external femoral torsion
6. tight lateral hamstrings

Question 19

how do you compensate for FF varus?

Answer 19

calcaneal eversion

if calcaneus everts beyond 4-6 deg, the STJ will maximally pronate and therefore can’t resupinate

Question 20

how do you compensate for flexible FF ?valgus

Answer 20

long axis MTJ supination

Question 21

how many degress of dorsiflexion do you need in a young child?

Answer 21

20-30 in a young child

15 deg in a 10-12 y/o

Question 22

how do you compensate for equinus?

Answer 22

1. STJ and MTJ pronation
2. medial column sag
3. tarsometatarsal breech
4. early heel-off

Question 23

a weak posterior tibial tendon has what effect on gait?

Answer 23

diminished supination of STJ

Question 24

what radiographic findings would you see in a lateral view of a flexible flatfoot?

Answer 24

• flattening of talar dome
• anterior break cyma line
• decreased calcaneal inclination angle
• increased talar declination angle

Question 25

what radiographic findings would you see in a AP view of a flexible flatfoot?

Answer 25

• increased talocalcaneal angle

- talonavicular articulation

Question 26

how would you treat a symptomatic flexible flatfoot?

Answer 26

• activity modification
• orthoses
• stretching
• NSAIDs
• manage obesity, ligamentous laxity, etc.

Question 27

at what age can you use orthotics?

Answer 27

3 y/o (do not use orthotics before then)

Question 28

describe congenital talipes calcaneovalgus deformity.

Answer 28

-limited plantarflexion of ankle joint and inversion
-everted position of the foot
(the foot is dorsiflexed, everted, and abducted against the leg)

Question 29

s/s of congenital talipes calcaneovalgus?

Answer 29

• skin wrinkling on dorsal-lateral aspect of foot
• foot may contact anterior aspect of tibia
• achilles tendon is not tight, even with max. dorsiflexion

Question 30

how should you treat congenital talipes calcaneovalgus?

Answer 30

serial stretching and casting that begins immediately! (prior to child walking)

Question 31

when is the golden age for treatment of congenital talipes calcaenovalgus?

Answer 31

3-12 months

prior to child walking

Question 32

what are some causes of rigid flatfoot deformities?

Answer 32

• congenital vertical talus
• tarsal coalition
• peroneal spastic flatfoot
• post-traumatic