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Pediatric Orthopedics > TEV-Clubfoot > Flashcards

TEV-Clubfoot Flashcards

1
Q

What are the 3 supination type podopediatric deformities?

A

TEV-Clubfoot
Cavus Foot
Metatarsus Adductus

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2
Q

What are the appendageal long axis changes from embryonic inception to adult form

A

~180 degrees (arm to leg)

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3
Q

What changes does the lower extremity foot go through from embryonic inception to adult form>

A
  • abduction
  • extension (DF)
  • medial rotation embryology of bone
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4
Q

Club foot is a Quadra planar deformity. What is the appearance?

A
  • equinus
  • hindfoot varus
  • forefoot adductus
  • forefoot cavus
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5
Q

____% of club foot is an isolated deformity

A

80%

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6
Q

What are the classifications for club foot

A
  • idiopathic TEV/ typical
  • Complex idiopathic CITEV/atypical
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7
Q

What are some causes of ITEV/typical club foot

A
  • positional (intrauterine molding)
  • delayed treated club foot
  • recurrent typical club foot
  • alternatively treated typical clubfoot
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8
Q

What are some causes of CITEV/ atypical clubfoot

A
  • rigid (high recurrence and can need more procedures)
  • syndromic (associated with other genetic abnormalities)
  • teratologic (associated with arthrogryposis/myelomeningocele)
  • neurogenic
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9
Q

What are the points dimeglio based clubfoot on

A
  • equinus
  • varus deviation
  • decoration around he talus-calcaneo-forefoot
  • abduction forefoot on hindfoot in horizontal plane
  • foot crease
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10
Q

What is 15-20 on Dimeglio scoring system?

A

Very severe

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11
Q

What is 10-15 on Dimeglio scoring system?

A

Severe

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12
Q

What is 5-10 on Dimeglio scoring system?

A

Moderate

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13
Q

What is 0-5 on Dimeglio scoring system?

A

Postural

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14
Q

What are their criteria for Pirani Scoring

A
  • lateral foot
  • dorsiflexion
  • medial fold
  • palpation of calcaneus
  • palpation of the talar head
  • posterior fold
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15
Q

What is the Pirani scoring system composed of?

A

Hindfoot and midfoot contracture score

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16
Q

What does the Pirani hindfoot contracture score consist of

A
  • posterior crease
  • empty heel
  • rigid equinus
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17
Q

What does the Pirani midfoot contracture score consist of

A
  • media crease
  • curvature of lateral border
  • position of head of talus
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18
Q

White is the Kite method

A

Gradual manipulation and casting
However did not allow heel to swing around talus

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19
Q

What are the characteristics of clubfoot

A

Equnivarus
Posterior skin crease
Medial skin crease
Navicular close to medial malleolus**
Short great toe
Hypoplastic skin over sinus tarsi

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20
Q

What happens to talocalcaneal angle on AP radiograph in TEV patient

A

It id decreased

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21
Q

What is normal talocalcaneal angle on AP film

A

30-55

22
Q

What is normal talocalcaneal angle on lateral film

A

25-50

23
Q

What happens to talocalcaneal angle on lateral film in TEV patient

A

Decrease toward an angle of 0

24
Q

What is normal tibiocalcaneal angle on lateral film

A

10-40

25
Q

What happens to tibiocalcaneal angle on lateral film in TEV patients

A

Angle is negative

26
Q

What is the normal talo-first metatarsal angle on AP view

A

15-20

27
Q

What happens to talocalcaneal-first metatarsal angle in TEV patients

A

Angle is negative (abduction of forefoot)

28
Q

How did Kite define clubfoot

A

Irreducible and reducible

29
Q

What did the Kite’s method emphasize about the benefits of casting

A

CORA is at the CC joint

30
Q

What is the manipulation sequence in Kite’s method

A

1 - correction of forefoot abduction
2 - correction of heel varus
3 - correction of hindfoot equinus

31
Q

How many times did casting fail with the Kite method

A

More than 50% of times

32
Q

What types of clubfoot deformities are not reducible without major surgery

A
  • arthrogryphosis multiplex
  • spinal bifida
  • phaecomyelias
33
Q

How did Poseti describe clubfoot

A

As a Quadra planar deformity flexed about a normal talus but with abnormal fibroblastic hyperplasia of the posteriomedial tendons and ligaments that created equino varus foot deformity

34
Q

When to start clubfoot manipulation with casting

A

Fibrous hyperplasia most rapid at birth until 4-5 years - intervene before 5 years
- technique harder with smaller feet
- no difference in results in children even up to 8 yrs
- typically start casting around 4 weeks of age

35
Q

What is the treatment for recurrent club foot

A

Tib anterior transfer

36
Q

What is Posenti magic movie

A

A dorsiflexory force is applied beneath the first metatarsal dead with counter pressure applied to the lateral talar head. This maneuver reduces the cavus and medial crease. This is performed as the forefoot is not inverted as compared to the hindfoot

37
Q

How much degrees is needed abduction bar in Ponseti treatment

A

50-70 degrees of affected foot, externally rotated
30-40 degrees of unaffected foot

38
Q

When do you perform a achilles tenotomy in clubfoot patients

A

If not able to dorsiflex the foot 15-20 degrees

39
Q

What structural features causes equinus to be improved in clubfoot patients,

A
  • once foot is abducted 60-70 degrees, because of kinetic coupling sometimes the equinus is improved a lot
    — this is because the anterior portion of the calcaneus is dorsiflexed as it swings under the talus with manipulations
40
Q

Post casting and Achilles tenotmy what is the angle foot orthosis protocol

A

Patient will wear an ankle foot orthosis with abduction bar at 70 degrees of abduction for 2-4 years

41
Q

If patient has a unilateral clubfoot, how much abduction on the orthosis bar is there

A

45 degrees

42
Q

What is the treatment for forefoot adductus in clubfoot relapse

A

Tib anterior tendon transfer

43
Q

What is the tib anterior attached to in a tendon transfer

A

Cuboid or lateral cuneiform

44
Q

How do you treat equinus in recurrent clubfoot

A
  • open Achilles tendon lengthening with posterior ankle joint capsulotomy if needed
  • z lengthening of Achilles tendon
  • V-Y lengthening of Achilles at musculo tendinoud junction
  • transverse ankle joint and subtalar capsulotomy
45
Q

What are the common surgical goals in club football surgery

A
  • posterior release
  • medial release
  • plantar release
  • lateral release
  • ‘fixation
  • soft tissue repair
46
Q

What are the pos op care for kite method for club foot

A
  • cast for 6 weeks
  • therapy dependent on age
  • less than 6 months = manipulative
  • greater than 2 years = ambulatory assistance
  • night splints until 4-7 years
47
Q

What is the best consistent long-term outcome result for clubfoot

A

Ponseti method

48
Q

What are the two minor surgical procedures which in resolution of clubfoot

A
  • percutaneous TAL
  • Percutaneous tibialis anterior tendon transfer for recalcitrant cases
49
Q

How to treat mature clubfoot

A
  • start Ponseti casting therapy ASAP post partum
  • Ponseti reductions possible up to age 7
50
Q

How do you treat neglected or recurrent clubfoot

A
  • talectomy
  • triple arthrodesis
  • pan-talar arthrodesis

Pediatric Orthopedics (18 decks)

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