Serial Casting Flashcards
Development of Foot
- Calcaneus appears: 24 - 26 fetal weeks
- Talus appears: 26 - 28 fetal weeks
- Cuboid appears: 40 fetal weeks
- Tibia & distal epiphysis appear: 6 months
- Fibula & distal epiphysis appear: 1 year (male), 9 months (female)
- Cuneiforms: 3 months - 2.5 years (male), 1.5 - 2 years (female)
- Navicular: 3 years (male), 2 years (female)
- Fibular maleolus: close 17 - 18 years
- Calcaneus epiphysis: close 12 - 22 years
- Navicular & Cuneiforms: closure varies
- Phalanges: close 18 years
- Distal tibial epiphysis: close 17 - 18 years
- Maleolus, medial tibia: 18 (male), 16 (female)
- Metatrsals: 14 - 21 years
Mature Gait Pattern
3 years
Neonatal LE Alignment
- Talar medial rotation & adduction
- early genu varum
- Medial leg rotation
- feet together
- more weight on lateral foot (protects medial/plantar ligaments)
1 Year Old Gait Development
- flat foot
- heel strike 1 - 1.5 years
- no reciprocal arm swing
- “high guard” arms
- knees flexed throughout gait cycle (hip flexor tightness)
- straight legs
- toes parallel to Mets
- max eversion
- normal CoM
Toe Walking
- More boys than girls
- Normal when learning how to walk (up to 2 years)
- Neurological condition if past 2 years (CP common)
- Serial casting safest
Intoeing
- Hard to fix with just casts
- Causes: femoral anteversion, internal tibial torsion, metatarsus adducted, clubfoot
Femoral Anteversion
- Anteversion is normal, excessive anteversion is usually due to ligamentous laxity
- usually resolves by 5 years old
Internal Tibial Torsion
- normal variant
- usually corrects itself with growth
- night splints may accelerate
Metatarsus Adductus
- Most common foot deformity
- associated with dysplasia of hip
- casting/splinting necessary if stretching doesn’t correct
- if persists 2+ years, surgical release is necessary
Outtoeing
Causes:
- Hip ER contracture (resolves spontaneously)
- femoral retroversion
- external tibial torsion (compensatory mechanism for excessive anteversion)
Bow Legs (genu varus)
- Normal up to 2 years
- Blount’s Disease or Rickets if longer
- splinting/surgery
- Blount’s Disease or Rickets if longer
- splinting indicated if 15+ degrees
- Won’t get full recovery if splinting 1 leg only
Knock Knees (genu vagus)
- usually resolve by 7 years
- common with CP, RA
Serial Casting
- most conservative treatment for bone alignment, muscle stretching, & neuromuscular re-education
- train for heel contact, weight shifting, & postural control
- Used for 3-4 days, every week (at least 3 times)
- CP, toe walking, DMD, spasticity, decreased ROM, TBI, Spina Bifida, intoeing, etc.
Considerations for Casting
- arousal, attention, cognition
- sensation integrity
- diseases/conditions that affect skin integrity
- clonus
- abnormal postural patterns
- neuroplasticity: reorganization, adaptation
- potential of functional use of involved areas
- family support
- independence level
- optimal motor learning & practice
Clubfoot (talipes equinovarus)
- congenital foot deformity affecting bones, muscles, tendons, blood vessels
- stiff, rigid, hard to manipulate
- appears short & broad, heel pointing down, while front half of foot turns inward
- tight heel cord
- common with CP & spina bifida
- risk of associated developmental dysplasia of hip
Positional Clubfoot
- affected foot is flexible
- caused by position in uterus
- easily positioned into neutral with hand
Clubfoot Treatment
Non-Surgical:
- 1st treatment, regardless of severity
- serial manipulation, casting, taping, PT, splinting
- Ponseti method (manipulation & casting) corrects within 2-3 months
- started as soon as diagnosis is made
- braces 23 hours/day for up to 3 months, then nightly for 2-4 years, to prevent relapse
Surgical:
- non surgical tx fails, deformity recurs
