Lecture 11-14 Flashcards
At 7 weeks gestation what happens to the limbs
Upper limb bud rotates external
lower bud rotates int
(femurs ext, tibias int)
-Torsional deformities arise when these processes are arrested or accentuated
overall diagnostic approach to examining lower limb
- Evaluate for foot deformity
- evaluate gait and coordination
- evaluate lower limb oath
- Evaluate for rotational profile
- Evaluate angular profile
- Incidental issues
a fallen arch is normal up to what age
10yold`
flexible fallen longitudinal arch is made up of what
Talus rot medially
calcareous rotated outwards
What are common foot conditions leading to intoning
Metatarsus Adductus
Bilateral Metatarsus Adductusq
What is metatarsus adductus
Adduction and inversion of the metatarsal bones resulting in in toeing
(normally line drawn thru heel should intersect the second/third toe space of the foot)
What is bilateral metatarsus adductus
Medial deviation of the forefoot, rounded lateral foot border
Pathology of toein
Tarsometatarsal jts subluxate medially
adduction and inversion of all 5 metatarsals
-hindfoot in neutral or valgus
What is the v finger test and what does it mean
The lateral aspect of the foot is observed from a plantar side for medial or lateral deviation from middle finger
-medial deviation from the middle finger at the styloid process indicateds MTA
incidence of toe lining and associated risk factors
1/500
Congenital dislocation of hips in 2-10% of cases
What is metatarsus virus
A fixed deformity caused by in utero subluxation
does NOT correct spontaneously after birth
What is calcaneovalgus foot and how does it look
the forefoot is abducted and the ankle is dorsiflexed (up and out appearance)
(seen in 30%, 1/1000 severe)
What is searching toe and why does it happen
Big toe points medially during gait
contracture of abductors during stance
What is club foot And what is it associated w
forefoot varus, heel varus, ankle equines
associated w CP, polio, neuromm disease
Tx for club foot (2)
Stretching/casting
Ponseti method- seriel casting
French method- taping and stretching
also surgery
If you see tip toe gait after 2 years what could it indicae
idiopathic toe walking
Neuro (CP, spinal dysgraphia, myopathy, neuropathy)
if u see out toeing what could it mean
External femoral tosion
External tibial torsion
IF you see in toeing what could it mean (3)
Metatarsus adductus
medial tibial torsion
internal femoral torsion
What is medial tibial torsion associated q
COngenital metatarsus adductus
Genu valgum
femoral anteversion
Torsion is diagnosed if
The rotation is >2 standard deviations from the mean
how to measure rotational profile according to staheli
- foot progession angle
- Int rot of the hip
- Ext rot of the hip
- Thigh foot angle
- Transmalleolar angle
Other ways to evaluate tibial torsion
Malleolar palpation (if at the same lvl then 20-30degrees int rot, normal is lat post)
Internal tibial torsion management
spontaneous resolution in 95% of children by 8
stretching
moderate/fixed should be surgical
causes of external tibial rot
Extremely rare
- -sleeping prone with the legs externaly rot
- my be secondary to femoral antevertion or IT band contracture
