Pie equinovaro Flashcards
(26 cards)
What is the overall incidence of clubfoot?
1:1,000, though some populations have an incidence of 1:250
Highest prevalence in Hawaiians and Maoris.
What is the male:female ratio for clubfoot?
Approximately 2:1
What percentage of clubfoot cases are bilateral?
Half of cases are bilateral
In what percentage of cases is clubfoot an isolated deformity?
80%
What does the acronym CAVE stand for in the context of clubfoot deformity?
Cavus, Adductus of forefoot, Varus, Equinus
What are the characteristics of the bony deformity in clubfoot?
Medial spin of the midfoot and forefoot relative to the hindfoot, talar neck is medially and plantarly deviated, calcaneus is in varus and rotated medially, navicular and cuboid are displaced medially
What is the genetic component associated with clubfoot?
Strongly suggested; unaffected parents with affected child have a 2.5% - 6.5% chance of having another affected child, familial occurrence is 25%
What transcription factor has been recently linked to clubfoot?
PITX1
Name associated conditions with clubfoot.
- Arthrogryposis
- Diastrophic dysplasia
- Myelodysplasia
- Tibial hemimelia
- Amniotic band syndrome (Streeter dysplasia)
- Upper extremity and hand anomalies common in this population
- Pierre Robin syndrome
- Opitz syndrome
- Larsen syndrome
- Prune-belly syndrome
- Anterior tibial artery hypoplasia or absence is common, regardless of etiology of clubfoot
What are common anomalies in children diagnosed with clubfoot in the first trimester?
Non-musculoskeletal anomalies are very common
What imaging view is recommended to assess clubfoot?
Dorsiflexion lateral (Turco view)
What is the success rate of the Ponseti method in avoiding comprehensive surgical release?
> 90%
What is the goal of the Ponseti method?
To rotate the foot laterally around a fixed talus
What is the most common treatment for untreated clubfeet?
Ponseti method of serial manipulation and casting
What are the indications for operative treatment of clubfoot?
- Resistant and/or recurrent feet in young children
- ‘Rocker bottom’ feet that develop after failed non-surgical intervention
- Syndrome-associated clubfoot if casting fails
What is a common procedure for severe, rigid recurrent clubfoot in children with arthrogryposis?
Talectomy
What is the critical factor for long-term success after Ponseti treatment?
Foot abduction orthosis (FAO) compliance
Fill in the blank: In clubfoot, _______ is needed in at least 80-90% of children.
Heel cord tenotomy
What are the common physical exam findings in clubfoot?
- Small foot and calf
- Shortened tibia
- Medial and posterior foot skin creases
- Rigid equinus and resistance to passive correction
- Midfoot in cavus
- Forefoot in adduction
What is the talocalcaneal angle in clubfoot?
< 20° (normal is 20-40°)
What is the significance of the talus-first metatarsal angle in clubfoot?
It is negative (normal is 0-20°) indicating that the talus points lateral to the first metatarsal
What is the common age for performing soft tissue release in resistant clubfoot?
9-10 months of age
What is the typical follow-up for postoperative management of clubfoot?
Requires postoperative casting for optimal results
True or False: Triple arthrodesis is often indicated in clubfoot treatment.
False
