Pediatric MSK problems Flashcards
1
Q
In-toeing/out-toeing torsion what should you look for/ask
A
- w-sitting is typical but with abnormalities it can exacerbate them
- history: want to know prenatal history, delivery etc
- age questions: when did you notice this and how is it affecting them
- family history: was someone else having issues with toeing in or out
- sleeping and sitting positions: ex: stomach sleeping can cause ER at hips
2
Q
Examination of pediatric MSK problems
A
- observe child walking especially when they do not know they are being watched
- supported stance foot progression angle (FPA): walking on a floor with a line to look at if they are diverting in or out form the line
3
Q
Contributing factors to in-toeing
A
- femoral anteversion
- internal tibial torsion
- metatarsus adductus
- w-sitting
4
Q
In-toeing clinical features
A
- tripping and falling often is a presentation
- often noticed around 2 years old
- internal rotation:
1. 70-80 degrees: mild FA
2. 80-90 degrees: moderate FA
3. 90 degrees= severe FA
5
Q
Internal Tibial Torsion- how can it be corrected in children?
A
- children may have to wear bracing that looks like a snowboard
- this will help turn out the tibia
- some braces are made to allow for more mobility
6
Q
Metatarsus adductus or varus causes
A
- infant foot
- caused by intrauterine pressure, osseous abnormality and abnormal muscle attachments
- some genetic component
- contractures of soft tissue around tarsometatarsal joints
7
Q
Out Toeing
A
- rare in infants
- detected when held upright
- should not go beyond 2 years of life
8
Q
causes of out-toeing
A
- slipped capital femoral epiphysis
- legg-calve-perthes disease (LCP)
- idiopathic osteonecrosis of the hip
- neuromuscular disorders
9
Q
External tibial torsion
A
- worsens over time
- late childhood and adolescence is when they are diagnosed
- rotational deformity
- requires surgery
- derotational tibial osteotomy
- will complain of pain
10
Q
- genu varum
A
- concerning if present after age 4 years
- if anterolateral bow of tibia = X-rays needed
- at risk of fractures the first year of life
- most common cause blount disease
- can be hereditary
11
Q
genu valgus
A
- many are overweight
- gait patterns is circumduction
- angular deformity, anterior and medial knee pain are common
12
Q
Talipes varus vs talipes valgus
A
- walks on the outter portion of the foot
- walks on the medial portion of the foot
13
Q
talipes equinus vs talipes calcaneus
A
- in more plantar flexion
- ankle in more dorsiflexion
14
Q
what is clubfoot/metatarsus adductus
A
- congenital talipes equinovarus
- 1-2/1000 births
- different grades of severity
15
Q
Clubfoot/metatarsus adductus: treatment/goal of treatmetn
A
- serial casting birth up to 9 years to get into typical position using ponsetti method
- may need surgery if casting does not work
- goals:
1. full loading
2. plantigrade position
3. wear normal shoes
16
Q
Post ponsetti method improvments
A
- ambulation improves
- development of milestones improves
- motor learning (if left in this position they will develop bad movement patterns)
- balance
- strenght
- functional movement skills
17
Q
Surgical correction of alignment abnormalities- what indicates it/what do they do?
A
- timing: so important generally earlier if casting is no working
- age dependent usually infants
- severity
- soft tissue release
- muscle transfer if muscles are not functioning
18
Q
Cavus foot
A
- abnormal elevation of the longitudinal arch of the foot
- forefoot equinus
- hindfoot calcaneus or varus deformity
19
Q
cavus foot and associated neurologic consitions
A
- 2/3rds have CP, spinal cord or charcot-marie-tooth disease (an immune disease that affects joints and causes them to maintain a contracted position - similar to arthritis)
20
Q
- surgical procedures of cavus foot
A
- soft tissue releases (plantar fascia)
- tendon transfer (especially with nerve damage)
- ostotomies: metatarsal, midfoot, or calcaneal osteotomies
- fusions: triple arthrodesis used as a last resort or children who are immobile to reduce risk of fractures
21
Q
when are feet normally flat until
A
- 2 years and sometimes 6 years
- there are flexibilty flatfoot and rigid flatfeet
22
Q
flexibile flatfeet
- signs
- treatment
- what occurs at subtalar and forefoot
A
- most common pediatric foot “deformity”
- uneven medial shoe wear down
- orthotics can improve uneven shoe wear
- tightness of the gastrocsoleus muscle
- higher incidence of flatfeet in blacks
- subtalar joint is DF, ER,
- midfoot: abducted
forefoot is supinated in relation to hindfoot
23
Q
Test for flexibility in flat feet
- windlass test or jack’s toes raising test
A
- looks at how flexible the plantar fascia is
- can be done in sitting or standing
- when the foot is flat on the ground you raise the big toe and watch if the arch height increases or decreases
24
Q
Calcaneovalgus:
- commonly seen
- treatments
A
- commonly seen with CP, spina bifida, idiopathic flatfoot
- treatments:
1. stretching
2. ankle foot orthosis or supramaleolar orthosis
3. sometimes surgery
4. serial casting
25
Q
rocker bottom foot
A
- less commone
- surgery is needed
- similar to calcaneovalgus
- sometimes with mild cases splinting is needed
26
Q
Knee injuries: adults in relation to kids
A
- lower incidence in children than in adults
- knee injuries are the most common cause of permanent disability in adults
