Chapter 47- Deformities Of Legs And Feet

Question 1

What is the layman term for congenital talipes equino- varus

Answer 1

Club foot

Question 2

What are the 4 deformities associated with club foot

Answer 2

• ankle equinus
• hindfoot varus
• forefoot adduction
• cavus

Question 3

Treatment of club foot

Answer 3

• serial plasters in first few days of life to correct forefoot adduction and hindfoot varus
• equinus deformity is corrected later
• soft tissue surgery may be required ( release of Achilles’ tendon
• neglected cases and special circumstances (Arthrogryposis, myelomeningocoele) further surgery may be necessary

Question 4

What is the position of the tarso-metatarsal joint, the sole and hindfoot in metatarsus adductus

Answer 4

• forefoot adducted at tarso- metatarsal joint
• sole: convex lateral border, concave medial side
• Hind foot in slight valgus/ normal

Question 5

Treatment of metatarsus adductus

Answer 5

Spontaneous correction in most cases but if it persists at one year it warrants referral

Question 6

Cause and presentation of calcaneovalgus

Answer 6

• Due to congenital vertical talus

- presents with rigid flat foot

Question 7

Persistence of a rotational deformity at what age will tend not to remodel

Answer 7

Age 8

Question 8

Causes of rotational deformities

Answer 8

• femoral rotation (version)
• tibial rotation
• forefoot position

Question 9

What is the trans- malleolar axis in adult

Answer 9

About 29 degrees of external rotation

Question 10

What measurement should one use to assess tibial torsion and what is the normal value

Answer 10

Thigh foot angle, usually it is 15-20 degrees externally rotated

Question 11

Does femoral anteversion cause in-toeing or out- toeing?

Answer 11

In -toeing

*retroversion will cause out- toeing

Question 12

When should you refer femoral version?

Answer 12

If they persist to the age of 8 and are symptomatic

Question 13

In the first year of life, what is the normal amount of lateral bowing of the legs?

Answer 13

15 degrees

Question 14

What is the adult pattern of valgus?

Answer 14

• 5 degrees of valgus in males

- 7 degrees in females

Question 15

What pathological conditions should be excluded in genu valgum?

Answer 15

Previous trauma/ infection of growth plate

Rickets

Question 16

What, on examination, suggests an underlying pathological condition in genu valgum

Answer 16

Very lax medial and lateral collateral ligaments

Question 17

What is measured every visit in genu valgum

Answer 17

Distance between the malleoli

Question 18

What operation can be done for genu valgum?

Answer 18

• operation on growth plates of the knee (stapling to inhibit growth on one side of the bone)

Question 19

What is the cause of Blount’s disease?

Answer 19

Inhibition of the medial growth plate of the proximal tibia

Question 20

How does Blount’s disease present?

Answer 20

Persistent/ progressive varies deformity of the tibia with internal tibial torsion

Question 21

What are the two groups of Blount’s disease?

Answer 21

• infantile form

- late onset form

Question 22

What is the management of Blount’s disease

Answer 22

Referral for corrective osteotomy

Question 23

What are the causes of rickets? Name the most common

Answer 23

• inadequate Intake or absorption of:
  Calcium
  Phosphorus
  vitamin D
• defects in the conversion of vitamin D to actually active form
• end Organ failure to respond to the effects of vitamin D
• most common: renal and those related to cerebral palsy

Question 24

X-ray findings for rickets

Answer 24

Osteopaenia, thinned cortices, flared or cupped metaphyses, widened epiphyses

Question 25

Investigations for the evaluation of rickets?

Answer 25

X-rays 
Ca, Mg, phos
PTH 
vitamin D studies 
Urinary Ph
Renal function

Question 26

What is done to correct angular deformities in rickets?

Answer 26

Corrective osteotomies and or physeal inhibition

Question 27

What is the most common type of flat- foot and how does it present?

Answer 27

• hyper- mobile flat foot
• obvious on weight- bearing but disappears in repose/child stands on tip-toe
• joints are fully mobile/ hyper mobile and easy to correct the deformity by grasping the heel and holding it at neutral
• may be slight tightness of tendo-Achilles when the foot is held neutral
• may be generalized ligamentous laxity

Question 28

When is referral for flat feet necessary?

Answer 28

• if the child is symptomatic : persist and excessive wearing out of shoes, fatigue, inability to keep up with friends, pain in their feet at the end of the day

Question 29

What are possible causes of rigid flat foot?

Answer 29

• congenital vertical talus
• tarsal condition
• neuromuscular conditions such as cerebral palsy, myelomeningocoele and poliomyelitis

Question 30

Treatment of rigid flat foot

Answer 30

Specialized surgical procedures

Referral is warranted

Question 31

What Neurological conditions should be looked for in pes cavus

Answer 31

• charcot- Marie- tooth
• Huntington’s chorea
• myelomeningocoele

Question 32

What Should one look for on examination of the foot in pes cavus?

Answer 32

• foot drop
• tight tendo-Achille
• fixed hindfoot varus
• fixed cavus
• clawing of the toes

Question 33

Investigations for pes cavus

Answer 33

AP and lateral standing views of the foot
Nerve conduction studies
Nerve biopsies