ankle and foot module 5

Question 1

what are some congenital foot deformities?

Answer 1

talipes equinovarus (clubfoot)
convex pes valgus
tarsal coalitions
talipes calcaneovalgus
metatsarsal deformities

Question 2

what are some metatarsal deformities?

Answer 2

metatarsus adductus (subluxation at the TMT jt)
metatarsus varus, adductovarus
forefoot adductus (subluxation at the MT jt)

Question 3

what is talipes equinovarus?

Answer 3

clubfoot
usually rigid deformity
inversion of the rearfoot, equinus (plantarflexion of the ankle and subtalar joint) and inversion and adduction of the forefoot
genetic factors, inter-uterine positioning and neuromuscular dysfunction have been implicated, 2 per 1000 live births, bilateral in 50% cases boys 2x more likely

Question 4

what is the treatment of clubfoot?

Answer 4

reduction of varus and later equinus component can be performed by gentle stretching, simulation of muscles
serial casting
ponseti brace or dennis/brown AFO
conservative treatment usually with good-fair results
surgery required in recalcitrant cases

Question 5

what is convex pes valgus/ vertical talus?

Answer 5

congenital vertical talus with dislocation of the navicular
can occur in isolation or with CNS abnormalities
valgus and plantarflexed rearfoot, midfoot rigidity and prone to ulceration when untreated
DF force causes convexity along the foot’s plantar aspect
can only be confirmed with Xrays

Question 6

what is tarsal coalitions?

Answer 6

heredity and congenital
incidence approx 6% general population
complete or incomplete fusion of the talus, calcaneous, cuboid, navicular and cuneiforms- abnormal growth between these bones
most common is the calcaneonavicular, followed by the talcalcaneal
subtalar motion becomes more limited into a valgus position when the TC, CN, or TN coalition occurs
rigid pronated foot can develop, symptomatic between 8-12 years old

Question 7

what is the treatment for tarsal coalitions?

Answer 7

relative rest, possibly short leg cast
oral anti-inflammatory medication
orthotics to control abnormal compensation

Question 8

What does surgical treatment of tarsal coalitions consists of?

Answer 8

Excision of the coalition with interposition of a fat pad graft

Question 9

When is subtalar fusion sometimes indicated?

Answer 9

If theres a collapsed arch

Question 10

What is talipes calcaneovalgus?

Answer 10

Foot in dorsiflexion and eversion, also bowing of distal tibia. Talus plantarflexed and calcaneus everted

Question 11

How common is talipes calcaneovalgus?

Answer 11

1/1000 births

Question 12

What causes talipes calcaneovalgus?

Answer 12

Inter-uterine position with a high correlation with flatfoot in older child

Question 13

How common is metatarsus adductus?

Answer 13

Most common causes of intoning in children, 1/1000-2000 live births less common in females

Question 14

What causes metatarsus adductus

Answer 14

Inter-uterine positioning or overactive abductor hallucis in children with cerebral palsy

Question 15

What percent of metatarsus adductus corrects itself?

Answer 15

90% by age 3, at 7 years 4% severe deformity, 10% moderate deformity

Question 16

What is the treatment for metatarsus adductus?

Answer 16

Poinsettia brace or Dennis/brown AFO: alternative to casting, early results with bar/show protocol in early ages 0-36 months, more cost effective than serial casting and can be taken on/off