Peds (Clubfoot)

Question 1

Metatarsus adductus (MTA)

Answer 1

• Forefoot adducted at tarsometatarsal joints
• Normal alignment of hindfoot and midfoot
• Full dorsiflexion

Question 2

MTA Grades

Answer 2

Alignment of middle of calcaneus with toes

• Normal: with 2nd toe
• Mild: with 3rd toe
• Moderate: between 3rd and 4th toes
• Severe: between 4th and 5th toes

Question 3

MTA Tx by Grade

Answer 3

Mild: Forefoot correctable beyond midline, No treatment needed, Corrects spontaneously by 4-6 months

Moderate: Forefoot correctable to midline, Straight last or reverse last shoes, Possible serial casting

Severe: Forefoot not correctable, Serial casting,
Surgery

Alternate philosophy: Watchful waiting - treat later if it does not resolve spontaneously

Question 4

Calcaneovalgus

Answer 4

• Hindfoot valgus
• Excessive dorsiflexion
• Corrects spontaneously

-Distinguish from rocker bottom foot (more rigid with vertical talus)

Question 5

Clubfoot - Talipes Equinovarus

Answer 5

-Forefoot curved medially
-Small calcaneus, hindfoot varus
-Ankle plantarflexion
-Calf atrophy, often absent or small anterior
tibial artery and dorsalis pedis (Cook S, 2008)

Question 6

Clubfoot Tx

Answer 6

-Casting, taping, splinting

-Surgery

Question 7

Ponsetti Method

Answer 7

-Ideally begin 7-10 days old
-Most effective before 9 months old
-Weekly manipulation followed by casting 5-6 cast changes
-May need tendo-Achilles lengthening (TAL)
before final cast
-Over correct in final cast
-Three weeks for healing
-If correction not seen at this point, will most
likely not work

Question 8

Ponsetti Procedure (serial casting)

Answer 8

-Correct cavus deformity: supinate forefoot to
align with hindfoot
-Simultaneously correct varus, inversion and
adduction of hindfoot deformities simultaneously
-Maintains strict mechanical interdependence of joint
-Cannot be corrected sequentially

Question 9

Ponsetti Procedure (post-casting)

Answer 9

Night splinting in abduction brace (Markell shoe)
►Full-time for 3-4 months
►Sleep until 2-4 years of age

Question 10

Clubfoot PT

Answer 10

Physical Therapy Intervention
►Children may not be referred for PT
►Goals
 Normal strength
 Normal mobility
 Normal positioning during gait
 Closed- and open-chain activities

Question 11

Foot Deformities - dorsiflexion

Answer 11

MTA - Yes
Talipes equinovarus - No
Calcaneovalgus - Yes

Question 12

Foot Deformities - foot shape

Answer 12

MTA - Bean
Talipes equinovarus - Bean
Calcaneovalgus - Banana

Question 13

Foot Deformities - heel position

Answer 13

MTA - Normal
Talipes equinovarus - Varus
Calcaneovalgus - Valgus