Paediatric Foot, Ankle and Spinal Problems

Question 1

By what other name is clubfoot known?

Answer 1

Talipes equinovarus

Question 2

What is talipes equinovarus?

Answer 2

A congenital deformity of the foot caused due to inutero abnormal alignment of the jonts between the talus, calcaneus and navicular leading to soft tissue contractures

Question 3

What are the 3 main deformities in talipes equinovarus?

Answer 3

1. Ankle equinus (plantarflexion)
2. Supination of the forefoot
3. Varus alignment of the forefoot

Question 4

Which sex is more commonly affected by talipes equinovarus?

Answer 4

Boys

Question 5

What are the main risk factors for talipes equinovarus?

Answer 5

1. Male gender
2. Family history
3. Breech births
4. Oligohydramnios (low amniotic fluid content)
5. Another coexistant skeletal dysplasia

Question 6

Which technique can be used to treat babies as soon as possible after birth?

Answer 6

Ponseti technique

Question 7

What does the Ponseti technique involve?

Answer 7

1. Deformities are corrected progressively by being held in evolving plaster casts with 5 or 6 weekly cast changes.
2. 80% of children require a tenotomy of the Achilles tendon
3. The child is placed in a brace when full correction is achieved
4. This brace is worn 23 hours a day for 3 months and then solely during sleep until the age of 3-4 to prevent recurrence

Question 8

How are delayed presentations of talipes equinovarus treated?

Answer 8

Extensive surgery involving bony and soft tissue procedures

Question 9

What is tarsal coalition?

Answer 9

When there is an abnormal bridge between the calcaneus and navicular or talus and calcaneus

This bridge can be bony, fibrous or cartilaginous

Question 10

What may tarsal coalition lead to in older children?

Answer 10

Painful fixed flat foot deformity

Question 11

How can symtpoms be improved for tarsal coalition?

Answer 11

Splintage/orthotics

(resistant pain may require surgery to remove the abnormal connection)

Question 12

When does hallux valgus usually present in terms of paediatrics?

Answer 12

Late adolescence

Question 13

Hallux valgus usually has a _______ family history

Answer 13

Strong

Question 14

What is the problem with surgical correction of hallux valgus in the adolescent age group?

Answer 14

This carries a risk of recurrence

Question 15

Back pain in children is a red flag, what 3 main things may it signify?

Answer 15

1. Infections (discitis)
2. Tumours (such as osteoid osteoma)
3. Spondylolisthesis

Question 16

What is scoliosis?

Answer 16

Lateral curvature of the spine

Question 17

Which sex is more commonly affected by scoliosis?

Answer 17

Females

Question 18

What may cause scoliosis?

Answer 18

1. Idiopathic
2. Neuromuscular disease
3. Tumours such as osteoid osteoma
4. Skeletal dysplasia
5. Infection

Question 19

Any painful scoliosis warrants what?

Answer 19

Urgent MRI

(to check for tumour or infection)

Question 20

What can severe scoliosis cause and why is surgery indicated in this instance?

Answer 20

Restrictive lung defect

Prevent breathing difficulties

Question 21

What is spondylolisthesis?

Answer 21

Slippage of one vertebrae over another

Question 22

Where does spondylolisthesis normally occur?

Answer 22

L4/L5 or L5/S1

Question 23

What may cause spondylolisthesis?

Answer 23

1. Developmental defect
2. Recurrent stress fracture of the posterior elements of the vertebrae which fail to heal

Question 24

Spondylolisthesis usually presents in whicha ge group?

Answer 24

Adolescents

Question 25

Why is it suggested that spondylolisthesis develops in adolescence?

Answer 25

1. Increased body weight
2. Increased sporting activity

Question 26

How do patients with spondylolisthesis present?

Answer 26

1. Low back pain
2. Radiculopathy (severe slippage)
3. Flat back (due to muscle spasm)
4. Waddling gait

Question 27

How is spondylolisthesis treated?

Answer 27

Minor - rest and physio

Severe - stabilisation and possible reduction