Pediatric Flatfoot Flashcards
Is the flatfoot pain usually better / worse with WB?
worse with WB
if pain is NWB, what other causes might you consider?
infection, arthridity, tumor
what is a skewfoot?
pronated rearfoot with adductovarus forefoot
what would you expect on a heel rise test if you had a flexible flatfoot?
heel would invert on heel rise
True of false: a young child with a cavus foot is MORE alarming than a flatfoot.
true
children have a pronated foot during development. this is normal until waht age?
7-8 y/o
what is the total ROM for a child? how much inversion? eversion?
total: 50-60 deg
inversion- 35-50 deg
eversion: 15-20 deg
what is the total ROM for an adult? how much inversion? eversion?
total: 25-35 deg
inversion- 20 deg
eversion- 10 deg
for a child that is 6y/o what is the normal maximum RCSP?
2 deg valgus
*calculate using:
8- (age of child)= max. RCSP
*use this equation for
what is considered a mild RCSP in children >7 y/o?
2-5 valgus
what si considered moderate RCSP in children > 7 y/o?
6-10 valgus
what is considered severe RCSP in children > 7 y/o?
> 10 valgus
What is Ryder’s test used to determine?
if there is excessive internal rotation of the hip
what is Ryder’s test?
place greater trochanter in frontal plane, and femoral condyles should be in line
what are the biomechanical causes of flexible flatfoot?
- excessive internal rotation of the hip
- excessive internal knee rotation
- internal tibial rotation
any type of excessive internal rotation causes what?
CKC pronation
= calcaneal eversion; talar plantarflexion and adduction; and tibial internal rotation
what are some causes of adducted gait?
- internal tibial torsion
- femoral anteversion
- tight medial hamstrings
- pigeon-toed deformity
what are some causes of abducted gait?
- met abductus
- forefoot abductus
- external malleolar torsion
- external tibial torsion
- external femoral torsion
- tight lateral hamstrings
how do you compensate for FF varus?
calcaneal eversion
if calcaneus everts beyond 4-6 deg, the STJ will maximally pronate and therefore can’t resupinate
how do you compensate for flexible FF ?valgus
long axis MTJ supination
how many degress of dorsiflexion do you need in a young child?
20-30 in a young child
15 deg in a 10-12 y/o
how do you compensate for equinus?
- STJ and MTJ pronation
- medial column sag
- tarsometatarsal breech
- early heel-off
a weak posterior tibial tendon has what effect on gait?
diminished supination of STJ
what radiographic findings would you see in a lateral view of a flexible flatfoot?
- flattening of talar dome
- anterior break cyma line
- decreased calcaneal inclination angle
- increased talar declination angle
what radiographic findings would you see in a AP view of a flexible flatfoot?
- increased talocalcaneal angle
- talonavicular articulation
how would you treat a symptomatic flexible flatfoot?
- activity modification
- orthoses
- stretching
- NSAIDs
- manage obesity, ligamentous laxity, etc.
at what age can you use orthotics?
3 y/o (do not use orthotics before then)
describe congenital talipes calcaneovalgus deformity.
-limited plantarflexion of ankle joint and inversion
-everted position of the foot
(the foot is dorsiflexed, everted, and abducted against the leg)
s/s of congenital talipes calcaneovalgus?
- skin wrinkling on dorsal-lateral aspect of foot
- foot may contact anterior aspect of tibia
- achilles tendon is not tight, even with max. dorsiflexion
how should you treat congenital talipes calcaneovalgus?
serial stretching and casting that begins immediately! (prior to child walking)
when is the golden age for treatment of congenital talipes calcaenovalgus?
3-12 months
prior to child walking
what are some causes of rigid flatfoot deformities?
- congenital vertical talus
- tarsal coalition
- peroneal spastic flatfoot
- post-traumatic
