Club Foot (Pod med) Flashcards
What is the Patho-anatomy of Clubfoot?
1?
2?
3?
4?
- Equinus (Ankle)
- Varus (through the Midtarsal joint)
- Adductus (Forefoot)
- Forefoot Cavus
What are the clinical examinations for Club foot?
1? poorly defined
Navicular abuts 2?
Talar head palpable 3?
Fibula and sinus tarsi are 4?
If unilateral the affected side the foot is 5?
Deep seated 6?
7? heel
Lower leg atrophy
LLD
In neglected cases adventitial bursa forms on the lateral
- Medial malleoli
- medial ankle
- laterally
- obliterated
- shorter
- medial skin creases
- “bean shaped”
Club Foot
Which ligaments are tight?
Whatever attached to navicular
1?
2?
3?
4?
5?
- Triceps surae complex
- Posterior ankle and Subtalar joint
- Deltoid
- Short and long plantar ligament
- Talo-calc interossei ligament
- Calcaneonavicular ligament
- All tendons in the tarsal tunnel area
Clubfoot
Which tendons are relatively elongates?
Extensors and peroneal tendons
Radiographic Evaluation of Club foot:
DP view:
1? angle
2? angle
Lateral view:
3? angle
Other modalities
CT, MRI
- Kite’s angle (between the talus and calcaneus) will be decreased
- Talo first metatarsal angle (more plantarflexed)
- Talocalcaneal (angle formed between the calcaneal inclination axis and bisection of the talus it is increased in pronation and decreased in supination (35-40))
Pirani evaluation
Pirani scoring system to assess the
severity of club feet:
1? normal
2? moderate
3? severe
- 0
- 0.5
- 1
What to look for when doing the Pirani scoring?
Midfoot
1?
2?
3?
Hindfoot
4?
5?
6?
- Lateral border
- Medial crease
- Talar head coverage
- Posterior crease
- Rigid equinus
- Empty heel
What does the Pirani score would tell you?
Scores:
> or equal to 5 require 1?
< or equal to 3.5 2?
b/w 3.5 and 5.0 3?
- tenotomy
- no tenotomy
- may need tenotomy
Ponseti’s method for casting:
The 1? deformity of the forefoot is corrected with the first cast
2? to place it in line with the rear foot
Next attempt is made to correct 3?
Thumb placed on the 4?
Lateral pressure on the 5?
• 4-5 casts maybe necessary to correct varus or inversion
- cavus
- Fore part of the foot is slightly supinated
- the inversion of the foot by moving all the bones distal to talus laterally
- lateral aspect of the head of talus (Fulcrum)
- first met and 1st cuneiforms
What is corrected the last and how?
1? with the heel in neutral or slight
valgus
Most difficult one to correct
Complication 2?
If after 3 casts still resistant then perform 3?
Equinus corrected last
- Dorsiflexing the foot
- rocker bottom deformity
- percutanous achilles tendon lengthening and place the foot in dorsiflexion in cast for 3 weeks
