By what other name is clubfoot known?
What is talipes equinovarus?
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
What are the 3 main deformities in talipes equinovarus?
- Ankle equinus (plantarflexion)
- Supination of the forefoot
- Varus alignment of the forefoot
Which sex is more commonly affected by talipes equinovarus?
What are the main risk factors for talipes equinovarus?
- Male gender
- Family history
- Breech births
- Oligohydramnios (low amniotic fluid content)
- Another coexistant skeletal dysplasia
Which technique can be used to treat babies as soon as possible after birth?
What does the Ponseti technique involve?
- Deformities are corrected progressively by being held in evolving plaster casts with 5 or 6 weekly cast changes.
- 80% of children require a tenotomy of the Achilles tendon
- The child is placed in a brace when full correction is achieved
- 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
How are delayed presentations of talipes equinovarus treated?
Extensive surgery involving bony and soft tissue procedures
What is tarsal coalition?
When there is an abnormal bridge between the calcaneus and navicular or talus and calcaneus
This bridge can be bony, fibrous or cartilaginous
What may tarsal coalition lead to in older children?
Painful fixed flat foot deformity
How can symtpoms be improved for tarsal coalition?
(resistant pain may require surgery to remove the abnormal connection)
When does hallux valgus usually present in terms of paediatrics?
Hallux valgus usually has a _______ family history
What is the problem with surgical correction of hallux valgus in the adolescent age group?
This carries a risk of recurrence
Back pain in children is a red flag, what 3 main things may it signify?
- Infections (discitis)
- Tumours (such as osteoid osteoma)
What is scoliosis?
Lateral curvature of the spine
Which sex is more commonly affected by scoliosis?
What may cause scoliosis?
- Neuromuscular disease
- Tumours such as osteoid osteoma
- Skeletal dysplasia
Any painful scoliosis warrants what?
(to check for tumour or infection)
What can severe scoliosis cause and why is surgery indicated in this instance?
Restrictive lung defect
Prevent breathing difficulties
What is spondylolisthesis?
Slippage of one vertebrae over another
Where does spondylolisthesis normally occur?
L4/L5 or L5/S1
What may cause spondylolisthesis?
- Developmental defect
- Recurrent stress fracture of the posterior elements of the vertebrae which fail to heal
Spondylolisthesis usually presents in whicha ge group?
Why is it suggested that spondylolisthesis develops in adolescence?
- Increased body weight
- Increased sporting activity
How do patients with spondylolisthesis present?
- Low back pain
- Radiculopathy (severe slippage)
- Flat back (due to muscle spasm)
- Waddling gait
How is spondylolisthesis treated?
Minor - rest and physio
Severe - stabilisation and possible reduction