Pediatric ortho 1 Flashcards
Metatarsus adductus, club foot, DHD
What is metatarsus adductus
Common congenital foot deformity with adduction of the forefoot and convexity of lateral border of foot
Single plane deformity
Cause of metatarsus adductus
Intrauterine position/crowing
What is metatarsus adductus related to
DHD, torticollis (other conditions caused by crowding)
Tx for metatarsus adductus for mild/flexible deformity
no tx, close monitoring, stretching + HEP by stabilizing heel and stretching laterally
Tx for metatarsus adductus for rigid
stretching, taping, splinting, corrective shoes
Tx for metatarsus adductus for fixed/severe
serial casts < 8 mo, surgery 2-4 years
V test
Test for metatarsus adductus
Infant heel is placed in webspace
Foot is observed from plantar surface
+: medial deviation of forefoot (away from middle finger)
What is club foot (talipes equinovarus)
Complex congenital deformity in 3 planes including PF, hindfoot varus, and forefoot adductus
Cause of club foot
Pathogenesis unknown
Multifactorial
Familial/genetic
Crowding (mild cases)
What is club foot associated with
Myelo + arthrogryposis
Management of club foot
Correct deformity, retain mobility + strength
Classifications of treatment for club foot
Positional: ROM, taping, splinting
Idiopathic: Ponseti management or French method
Main goal of club foot treatment
Foot in WB position to correct deformity
Ponseti method
Consists of manipulation and serial casting, bracing
Serial casting progression (6 weeks)
C: cavus
A: adductus
V: varus
E: equinus
French method (physiotherapy taping) for clubfoot
Daily stretching
Mobilization
Taping to maintain correction
Molded plastic splint
parent education
T/f relapse is common with club foot
T
Developmental hip dysplasia
Spectrum of anatomic abnormalities that may be present at birth or develop afterward.
Hip may be dysplastic, subluxable, dislocatable, or dislocated
Risk factors for DHD
Female (more estrogen, more laxity)
Breech (More unstable pos)
LGA (crowding)
Prenatal + postnatal etiology for DHD
Prenatal
1. Intrauterine pos
2. Oligiohydramnios (limited fetal movement)
3. Embryonic development (myelo + arthrohryposis)
Post natal
Shallow acetabulum and ligament laxity; femoral head unable to stay in acetabulum
Galeazzi sign
DHD test
Hook lying pos: knee lower on displaced side
abduction/adduction test for DHD
Observe for symmetrical spontaneous movement at the hips
Limited abduction of thigh when flexed on displaced side
Other signs of DHD
Extra skin folds
Barlow + Ortolani manuevers
Management of DHD depending on age
Observation
Pavlik Harness < 6 mo (puts hip in F + ABD)
Bryant’s traction, closed reduction, abd splint/spica cast progression (6-12 mo)
Surgery > 12 mo
