Q4: Metatarsus Adductus/Talipes Equinovarus & Post Polio Flashcards
Etiology
Metatarsus Adductus
- 1-2 out of every 1000 births
- Idiopathic but can be connected to family history
- equal among men and women
- 50% of cases are bilateral
Presentation
Metatarsus Adductus
- Forefoot Adducted
- Supinated
- Int. Tibial Torsion
- Neutral Hindfoot
- Full Ankle ROM
Banana Foot
Diagnostic Technique
Metatarsus Adductus
- Visual Assessment
- Passive Manipulation (flexibility)
- Imaging for severe cases
Classification Scale
Metatarsus Adductus
Heel Bisector Line - comparison of hindfoot axis to the toes it crosses
Normal = 2 toe, Mild = 3 toe, Mod. =. 3/4 toe webspace, Severe = 4/5 toe webspace
Can test for flexibility back to neutral (hold hindfoot push on 1 met)
Non-Ox Intervention
Metatarsus Adductus
Intervention early in first few weeks of life
* Passive stretching (diaper changes)
* Avoid sleeping face down with curled feet
* Serial Casting
* Surgical Intervention only in severe cases (Wedge Osteotomy)
Ox Intervention
Metatarsus Adductus
- Straight Last shoes
- Reverse Last shoes
- Bebax Boot - static progressive/adjustable
- Wheaton AFO/KAFO - prefab; medially ext. foot trims
- Custom AFO - forefoot ext. and abduction
Etiology
Talipes Equinovarus (Clubfoot)
- 1/1000 births
- Idiopathic but may have family history correlation
- 70% male
- 50% bilateral
Can be underlying condition to Arthrogryposis or Spina Bifida
Presentation
Talipes Equinovarus (Clubfoot)
- Pes cavus
- Adducted forefoot
- Hindfoor varus
- ankle equinovarus
- LLD
- crease on MLA
Diagnostic Techniques
Talipes Equinovarus (Clubfoot)
- Visual Assessment
- Imaging
Classification Scale
Talipes Equinovarus (Clubfoot)
Pirani Score for CTEV; higher the score the more severe
Non-Ox Intervention
Talipes Equinovarus (Clubfoot)
French Functional Method
* dynamic manipulation stretching
* immobilization with taping
* clinician for 3 months…then parents
Surgical Correction
* only for recurrent cases
* historically unsuccessful
Ox Intervention
Talipes Equinovarus (Clubfoot)
Ponseti Method
1. Serial Casting (3-8 weeks)
2. Achilles tenetomy
3. Ox intervention -> 3-6 months for 23 hrs/day; then nighs/naps for 3-4 years
Ox designs: Dennis Brown Bar, Dobb’s bar, Ponseti Bar
Poliomyelitis - Etiology
Post-Polio
viral infection that can affect the anterior horn cells causing motor paralysis
* sensation intact
* contagious (through GI)
* commonly under 5
* No treatment
Types of Polio
Post-Polio
Abortive - flu like; no long term effects
Nonparalytic - systemic symptons from swelling in CNS
Paralytic - attack brain and spinal cord
Polioencephalitis - rare; infants
Prevention of Poliomyelitis
Post-Polio
Vaccines!
1. injectable - 4 doses total
2. oral - inactive or active virus
