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Pediatric Feet Flashcards

(75 cards)

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1
Q

Normal foot

A

plantar grade
“neutral” hindfoot
plum line should intersect with the posterior border
medial and lateral borders of the foot are straight

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2
Q

Tripod

A

Foot acts as a tripod - lateral, medial, and posterior rays- with weight bearing spread across the calcaneous

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3
Q

Hx of foot deformity

A

CC
Hx of CC - pain, deformity?
what is the issue of deformity?

Think: is it a problem with abnormal walk?
was it something gradual (onset) or acute?

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4
Q

Gradual onset

A

DDx: spinal dysraphism
neuromuscular disease
congenital

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5
Q

Acute onset

A 
DDx: trauma 
fx
abuse 
strain
sprain 
infection
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6
Q

PE of the foot

A

watch them walk !!!!

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7
Q

What are you looking for in a PE

A

-muscle atrophy- asymmetry
-swelling – affected or distant area
-deformity, rotational position – what normals are for rotation ?
-angular position
-hindfoot position
Active range of motion – need to know normal
Passive range of motion
Muscle testing- muscle strength
Neurologic exam
-Patellar &Achilles deep tendon reflexes
-Babinski test (UMN)

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8
Q

Infant benign foot deformities

A

Congenital

  • simple polydactyly
  • simple syndactyly
  • metatarsus varus (adductus)
  • calcaneovalgus
  • congenital curled toe
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9
Q

Infant pathologic foot deformities

A

Congenital

  • complex polydactyly
  • complete and/or complex syndactyly
  • club foot
  • vertical talus
  • cleft foot
  • macrodactyly
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10
Q

Polydactyly

A

congenital foot deformity
often an isolated trait
small nubbin on lateral border of the foot (post axial)

extra bones

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11
Q

Preaxial polydactyly

A

either thumbs for upper extremities or big toes for lower extremities have nubbin

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12
Q

Postaxial polydactyly

A

little finger or toe has nubbin

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13
Q

What is a nubbin?

A

collection of tissue with artery and vein
Tie off the nubbin => will turn dry gangrene and fall off few days to wks

may have nail => indicate little bone

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14
Q

Goal of tx of polydactyly

A

be able to wear shoes comfortably
-> need to surgically remove
surgically remove to insure comfortable shoe wear

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15
Q

Syndactyly

A

failure of programmed cell death- sporadic cases are 80%

mesenchymal limb bud -> AER -> signaling of cell death defective -> webbing of the fingers (skins only)

Usually occurs between 3rd/4th toes
occurs bilaterally/symmetrical

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16
Q

Variations of syndactyly

A

Complete
Incomplete
Simple
Complex

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17
Q

Complex syndactyly

A

webbing the entire length of the digit

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18
Q

Incomplete syndactyly

A

webbing partial length of digit

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19
Q

Simple syndactyly

A

soft tissue union

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20
Q

Complex syndactyly

A

bony union

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21
Q

Surgery indications for syndactyly

A

FOR THE FEET, ONLY DO SURGERY if SHOE WEAR IS DIFFICULT

THETHERING DEFORMITY ON THE FINGERS DUE TO SYNDACTYLY – NEED SURGERY

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22
Q

Etiology of the Packaging defects

A

First pregnancy
Multiple gestation
large baby

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23
Q

Packaging defect

A

plegiocephaly - head misshapen
frontal bone is more prominent than another side
eyes and ears are asymmetric

metatarsus varus
calcaneovalgus
clubfoot

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24
Q

Metatarsus varus (adductus)***

A

result of packing defect

Mild>moderate = medial border of the foot curves inward 
severe = medial border of foot curves inward and it's stiff
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25
Mild/moderate vs severe metatarus varus
``` Mild/moderate = flexible severe = stiff ```
26
PE metatarus varus
ALWAYS CHECK THE HIPS | gentle manipulation of foot with diaper changes
27
Tx metatarus varus
start putting them on shoes corrective shoes - straight last , reverse last, be back shoes rarely require surgery
28
When will a reverse shoe not be tolerated
severe metatarsus varus because they are not flexible | will have skin problems if given reverse shoe
29
Calcaneovalgus
packing defect benign non position foot flexible foot position corrects with gentle manipulation foot is dorsiflexed to the tibias anterior DDx : vertical talus or fibular hemimelia PE: always check the hips
30
Serial casting
can be used to tx metatarsi varus -refer to orthopedic surgeon rarely needed for calcaneovalgus Doesn't work for vertical talus
31
Calcaneovalgus present with hip dysplasia
unilateral CV | foot splay?
32
Congenital curled toe****
-result from contracture -presentation: standing on the lateral aspect of the little toe -shoe wear is a problem do surgery but it is of high risk
33
Clubfoot *
- Idiopathic : unknown - a packaging defect - arthrogryposis - resistant = foot doesn't respond well - myelodysplasia - marrow dysplasia - hereditary ABNORMAL MESENCHYMAL TISSUE IN THE MEDIAL BORDER
34
Associated problem with clubfoot
spinal dysphargism = particularly if the foot is bent unilaterally
35
Tx of clubfoot
nonoperative - need two different shoe sizes infants - stretch, cast to correct the talocalcaneal joint => ensure that aspiration is resolved wait until children is 5-6 mon to a year to do a surgery talus and subtalus and talus/navicular joints need to be open
36
Dx of clubfoot
check hips for dysplasia or instability | check spine for sacral clefts, dimples, hairy patches
37
Presentation of clubfoot
pt stands on dorsolateral of the foot development of the leg affected is thinner limb on the affected side is always smaller
38
Sx of clubfoot
``` posterior crease medial crease empty heel pad adducts of forefoot varus of hind foot supination mid/forefoot ```
39
Differentiate b/n clubfoot and metatarsus !!!
Posterior crease is deep medial crease - only soft tissue = calcareous is not at the anatomical position hind foot is varus (point inward) mid foot and forefoot are supinated
40
Vertical talus **
Rockerbottom foot - > rigid foot = can't plantar flex = AKA RIGID HINDFOOT VALGUS This is a pathologic condition
41
DX vertical talus
palpate the head of the talus through the skin
42
Presentation of vertical talus
weight bearing on the head of the talus
43
Tx of vertical talus
-cant reduce mid foot and talus | refer to orthopedic surgeon to restore tripod
44
Macrodactyly
pathologic = overgrowth syndrome gigantism of bones, muscles, nerves (4x size), vasculature population: seen in AMISH people
45
Tx of macrodactyly
refer to ortho surgeon | goal is to wear comfortable shoes
46
Cleft foot***
central failure of formation | can happen in hand and feet
47
Acquired foot deformity
1. Pes planus - flat feet - flexible - rigid: tarsal coalition 2. Cavus - serious pathological condition - need to know Ddx * **cavovarus
48
Presentation of a child with flat foot
the medial side is not well balanced | bottom of the foot is blanched
49
longitudinal foot in a toodler
NORMAL | less than 2 y/o
50
A 2 y/o has a longitudinal arch
DDx : spinal dysphyragism | congenital spinal and neuromuscular diseases
51
Pes Planus
BENIGN rarely symptomatic **subluxation of the talonavicular joint***** * *flattened longitudinal arch - mild - moderate - severe * *hindfoot valgus * *Flexible * *Rigid
52
presentation of per planus
walking on the talus acquired vertical talus flexible - assoc. with ligamentous laxity
53
Flexible pes planus***
DDx ligamentous laxity tight tendoachilles overcorrected clubfoot fibular longitudinal deficiency - absence of the fibula (no lateral strut of the fibula) => this can clue in on leg length deficiency and it is a congenital problem!
54
Test for flexible flat feet
how can you tell flexibility? stand on toes | arched support may be needed but RARE
55
Hind foot valgus - Pes planus
subtalar instability | ankle instability
56
Notes on hind foot valgus - per plans
LOW GRADE SPINAL BIFIDA FIBULA IS ATROPHIC – INDICATION OF PARTIAL PARALYSIS GROWTH PLATE FIBULA DID NOT GROW AS WELL DISTAL TIBIA SHOULD BE PARALLEL WITH THE TALUS BUT ITS NOT TWO SCREWS ARE PUT IN – THEN , MEDIAL ASPECT OPENS UP TETHER THE SIDE THAT IS GROWING !
57
Rigid pes planus
Tarsal coalitions - fibrous, cartilagenous, boney nonpainful painful - refer to ortho
58
Tarsal coalitions
an abnormal connection that develops between two bones in the back of the foot (the tarsal bones) 50% -60 % of coalitions are bilateral Peroneal spasm!!!!!
59
Synostosis tarsal coalition
boney coalition
60
synchondrosis tarsal coalition
cartilagious coalition
61
syndesmosis tarsal coalition
fibrous coalition
62
Sites of tarsal coalitions
**Calcaneonavicular - begins to ossify @ 8-14 yrs. **Talocalcaneal - begins to ossify 12 yrs to adult **Calcanealcuboid Talonavicular Navicularcuboid Navicularcunieform
63
Accessory navicular
Pes planus TIBILARIS POSTERIOR INSERTS at the point in navicular CAN TEST THIS BY HAVING PATIETNT ABDUCT FOOT AND TRY TO ADDUCT IT AGAINST RESISTANCE
64
Cavus/cavovarus***
Genetic Increased height of longitudinal arch Hindfoot varus-ALL WEIGHT BEARING ON THE LATERAL SIDE Claw Toes Deformities may be flexible or fixed MUSCLE IMBALANCE FROM SENSORY/MOTOR NEUROPATHY MIDDLE CREASE
65
Tx goal for cavus
RESTORE PLANTAR GRADE BEST THEM TO GO TO A NEUROLOGIST PCP WILL DO THAT
66
underlying causes of cavus (conditions are PROGRESSIVE AND DEGENERATIVE)
``` Charcot-Maire Tooth Disease Spinocerebellar Degenerations Myelodysplasia Polio Spastic Monoplegia or Dyplegia Polyneuritis Myopathy Trauma Spinal Cord Tumor Occult Spinal Dysraphism Arthrogryposis Congenital Lymphedema Congenital Syphilis Residual Clubfoot Deformity ```
67
Workup for Cavus
``` Detailed history Prenatal Perinatal Developmental history Family Medical History Onset of deformity (congenital, gradual,rapid)- SORT OUT DDX Functional Status***ESP FOR OLDER PTS ```
68
PE of Cavus
``` WATCH THEM WALK Examine Gait Muscle Strength Testing Reflexes Upper and Lower Extremities Muscle Tone & testing for strength Clonus-INVOLUNTARY MUSCLE CONTRACTION Babinski Sign Superficial Abdominal Reflex SUBTLE WEAKNESS OF TIB ANTERIOR COMPENSATING Meticulous Examination of the Spine Skin Posterior & Sagital views Palpate for defects- SPINA BIFIDA CAN BE A DDX ```
69
Referral of Cavus
``` Neurology EMG & Nerve Conduction Studies MRI (head &/or spine) Muscle &/or Nerve Biopsy Genetics DNA Testing ```
70
Lab tests for Cavus
CBC with Diff Urinalysis CPK prn
71
XR measurement of Cavus
**** LINES SHOW CAVUS | 1ST LINE – FIRST RAY (TOP PIC)
72
Kelikian’s “Push-up” Test
Test for Cavus TOES CLAWED NO MATTER WHAT HAPPENS TO METATARSAL HEADS
73
Non surgical Tx of Cavus
Stretching contracted plantar fascia Insoles for painful flexed metatarsal heads Shoes , Braces & Orthotics DO NOT correct or prevent deformity- NOT USEFUL – COSTLY Orthotics in flexible deformity AFO with dorsiflex assist
74
Goal tx of caves
MAINTAIN AND PROMOTE FUNCTION WITHOUT SHOE WEAR PROBLEMS
75
Goal tx of caves
MAINTAIN AND PROMOTE FUNCTION WITHOUT SHOE WEAR PROBLEMS

Musculoskeletal System (27 decks)

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