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YR3S2- PM4 > wk 5 - rotational > Flashcards

wk 5 - rotational Flashcards

1
Q

what causes positional deformities in fetus

A

intrinsic cause:
-neuromuscular disorders causing decreased fetal movement
-renal disease resulting in decreased production of amniotic fluid and oligohydramnios, increases fetal compression

extrinsic cause:
-things that cause fetal crowding and restrict fetal movement

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2
Q

2 elements that cause deformations to fetus

A
  1. restricted fetal movement
  2. fetal compression

fetal movement is required for normal musculoskeletal development in extremities

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3
Q

during what period do external compression increase and amniotic fluid decrease

A

third trimester where deformities most commonly arise

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4
Q

hip dysplasia

A

abnormal development/ contact of the acetabulum and proximal femur causing mechanical instability of the hip joint

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5
Q

risk factors for hip dysplasia

A

-female gender
-breech position (baby hasnt turned in womb)
-family history

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6
Q

assessments of hip dysplasia

A
  1. ortolani maneuver
  2. barlow maneuver
  3. galeazzi test
    4.US/ radiographs after 4-6months of age (before this time the structures are unossified)
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7
Q

internal tibial torsion caused by and causes what?

A

caused by intauterine (womb) positioning

is the most common cause of in toeing in toddlers
can also be associated with metatarsus adductus and genu varum

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8
Q

does internal tibial torsion require treatment

A

usually resolves after normal growth, intervention isn’t usually required

surgery is only required for an older child where there is obvious functional deformity

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9
Q

external tibial torsion

A

caused by intrauterine positioning

most common cause of out toeing and more likely to persist throughout teenage years than internal

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10
Q

genu varum

A

caused by womb positioning
caused by external rotation at the hip due to tight posterior hip capsule and internal tibial torsion

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11
Q

what could genu varum also be? Dx:

A

blounts disease
rickets

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12
Q

metatarsus adductus

A

forefoot that is abducted at the tarsometatarsal joints in relation to hindfoot (transverse plane)

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13
Q

blecks scale for classifiying matarasus adductus

A

drawing a line straight down the middle of the heel to toes:

Normal – bisection of 2nd Digit
* Mild – Bisection of 3rd Digit
* Moderate – Between 3rd/4th Digits
* Severe – Between 4th/5th Digit

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14
Q

if youre going to get a radiograph what do u need to remember

A

bones havent ossified

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15
Q

what could metatarsus adductus also be? Ddx:

A

skewfoot

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16
Q

what. are u looking for on radiograph to diagnose metatarsus adductus

A

medial deviation of 1st met from the talus first met line

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17
Q

skewfoot shows what on a radiograph

A

the same as metatarsus adductus: medial deviation of 1st met from the talar fitst met angle

AS well as

valgus deformity of the hindfoot, with a talocalconeal angle more than 35 degs on AP radiograph and 45 degs on lateral radiograph

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18
Q

what do you need to find out about an metatarsus adductus

A

positional - using blecks classification
flexibility- rigid, semi rigid, flexible

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19
Q

how do you test for flexibility of a metatarsus adductus

A

hold heel in neutral and ABDuct forefoot against rearfoot

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20
Q

grading flexibility of metarasus adductus

A

grade 1 (flexible)- deformity correctable past midline
grade 2- (semi rigid)- deformity correctable to midline
grade3 - (rigid)- deformity cannot be corrected to midline

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21
Q

treatment for mild blecks scale/flexible MA

A

nil

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22
Q

treatment for mod blecks scale/flexible MA at 4-8months, 8-10 months, walking

A

4-8months: brace/splint
8-10months: casting and SLS/night splint
walking: 1-2 casts and SLS, orthoses and night splint

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23
Q

treatment for severe blecks scale and semi rigid MA

A

4-8months: serial casts followed by abduction orthoses /night splint

8-10months: casting and SLS/night splint

walking: 1-2 casts and SLS, orthoses and night splint

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24
Q

treatment for skew foot

A

footwear, orthoses, surgery

25
Q

SLS stands for

A

straight last shoes

26
Q

if you dont treat MA what could happen

A

deformities
-metatarsus primus vaurs (abduction of great toe)
-hallux valgus
-hammer toes
-medial tibial torsion
-in toeing

functional
tripping
shoe fitting
aesthetic concerns
plantar pressure differences

27
Q

flexible metatarsus adductus, do u need to treat?

A

good evidence that you dont need to and that the child will continue to derotate as they get older

recommendations could be stretching, SLS

28
Q

can a rigid MA get better after the 1st year?

A

low evidence showing it gets better as bones start to ossify

29
Q

what is serial casting

A

cast below the knee holding the forefoot in a rectus position

cast is changed every 1-2 weeks for a period of up to 12

30
Q

what is serial casting good for

A

semi rigid MA

31
Q

cons of serial casting

A

-time, multiple visits
-skin irritation/cut flow off
-child not able to give feedback
-emotional trauma/quality of life

32
Q

what is weaton brace and what is it good for

A

mod to severe MA

piece of thermoplastic that is moulded to the desired correction of the patients foot

worn for 24 hours a day until correction then suggested 4 weeks of night use to maintain

33
Q

pros and cons of wheaton brace

A

pros
-dont need to revisit clinic
-can remove for hygiene
-same results as serial casting

cons
-non weightbearing device

34
Q

what is bebax orthotics

A

leather shoe with a hinge

worn 21-24 hours per day with 20 degrees outflare, then after 4-6 weeks changed to 45 deg flare and worn for 16-18 hours per day

35
Q

bebax orthotics good for

A

semi rigid and rigid MA early in life

36
Q

pros and cons of bebax orthotics

A

pros
-less expensive than casting
-can be adjusted

cons
-requires high parent paritcipation
-not for weightbearing (6-12 months or earlier is good for)

37
Q

what is corrective bandage

A

starts with corrective maniulation to flex retracted muscles of foot for 5 days per week for 15mins

after which, cotton bandage is applied from toe to knee.

38
Q

what is corrective bandage good for

A

semi rigid MA in 1st month of life

39
Q

pros and cons of corrective bandage

A

pros
-cost effective
-can be removed

cons
-training in manipulation
-low efficacy
-best done in 1st month of life

40
Q

what is a denis browne bar

A

holds foot in externally rotated position

41
Q

what is denis browne bar good for

A

all types of MA, skewfoot

42
Q

pros and cons of denis browne bar

A

pros
-good for babies that sleep in prone position

cons
-used with caution as holding foot in rearfoot valgus position so there is increased risk of having flat foot deformity after treatment

43
Q

what are reverse last shoes

A

opposite shoe wearing

44
Q

what do reverse last shoes cause

A

Hallux valgus deformity

45
Q

devices for MA

A

UCBL- high heel cup, medial/lateral flange

SMO- around lat and medial mall

not enough studies done to prove efficiacy

46
Q

what is a turtle brace and what could it help with

A

heat mouldable thermoplastic cast that allows walking on

47
Q

talipes calcaneovalgus feet are

A

hyperdorsiflexion of the foot with abduction of the forefoot which often results in the forefoot restong on the anterior surface ofthe lower leg

48
Q

talipes equino varus (clubfoot)

A

foot excessively plantarflexed with forefoot swing medially and soles facing inward

49
Q

types of clubfoot

A
  1. positional (breech)
    2.congential -most common
  2. syndromic
50
Q

treatment for clubfoot

A
  1. serial casting with denis browne bar at night to maintain correction
  2. surgery (tenotomy)- lengthening of achilles tendon
51
Q

causes of intoeing in infants, toddler and children

A

infants (1-2): MTA
toddler (2-3): internal tibial torsion
children (3 or mroe): femoral torsion

52
Q

ryders test does what

A

tests femoral torsion

53
Q

foot thigh angle tests what

A

tibial torsion

54
Q

trans malleolar axis tests what

A

tibial torsion

55
Q

if the patella is mediall rotated then

A

there is a femur component thats cause intoeing

56
Q

if the patella is straight and feet adducted then it could be

A

medial genicular bias
medial tibial torsion
psudeomalleolar torsion
MTA

57
Q

Difference between tibial torsion and medial genicular bias during gait

A

in-toe due to medial tibial torsion is usually consistent whereas, in-toeing
due to medial genicular position tends to be more variable (step to step

58
Q

medial genicular bias is caused by

A

lack of range in the body

59
Q

most common causes of out toeing

A
  1. external rotation contracture of hip
  2. External tibial torsion
  3. femoral retroversion (rare)

YR3S2- PM4 (9 decks)

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