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Common Pediatric Foot Deformities

Common Pediatric Foot Deformities. Objectives. Be familiar with the anatomy of the foot Differentiate varus and valgus deformities Understand Metatarus Adductus Understand the management of clubfoot Understand when to treat pes planus. Anatomy/Terminology. 3 main sections

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Common Pediatric Foot Deformities

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  1. Common Pediatric Foot Deformities

  2. Objectives • Be familiar with the anatomy of the foot • Differentiate varus and valgus deformities • Understand Metatarus Adductus • Understand the management of clubfoot • Understand when to treat pes planus

  3. Anatomy/Terminology • 3 main sections • Hindfoot – talus, calcaneus • Midfoot – navicular, cuboid, cuneiforms • Forefoot – metatarsals and phalanges

  4. Anatomy/Terminology Important joints 1. tibiotalar (ankle) – plantar/dorsiflexion 2. talocalcaneal (subtalar) – inversion/eversion Important tendons 1. achilles (post calcaneus) – plantar flexion 2. post fibular (navicular/cuneiform) – inversion 3. ant fibular (med cuneiform/1st met) – dorsiflexion 4. peroneus brevis (5th met) - eversion

  5. Anatomy/Terminology • Valgus - Angulation of a bone or joint in which the apex is toward the midline; genu valgum results in knock-knee because the angulation of the knee is toward the midline

  6. Anatomy/Terminology • Varus - Angulation of a bone or joint away from the midline; genu varum results in bowleg because the angulation is away from the midline

  7. Calcaneovalgus foot

  8. Calcaneovalgus foot • ankle joint dorsiflexed, subtalar joint everted • classic positional deformity • more common in 1st born, LGA, twins • 2-10% assoc b/w foot deformity and DDH • treatment requires stretching: plantarflex • and invert foot • excellent prognosis

  9. Congenital Vertical Talus • true congenital deformity • 60% assoc w/ some neuro impairment • plantarflexed ankle, everted subtalar joint, stiff • requires surgical correction (casting is • generally ineffective)

  10. Talipes Equinovarus (congenital clubfoot) • General • - complicated, multifactorial deformity of • primarily genetic origin • - 3 basic components • (i) ankle joint plantarflexed/equines • (ii) subtalar joint inverted/varus • (iii) forefoot adducted

  11. Talipes Equinovarus (congenital clubfoot)

  12. Talipes Equinovarus (congenital clubfoot) B. Incidence - approx 1/1,000 live births - usually sporadic - bilateral deformities occur 50% C. Etiology - unknown - ?defect in development of talus leads to soft tissue changes in joints, or vice versa

  13. Talipes Equinovarus (congenital clubfoot) • D. Diagnosis/Evaluation • - distinguish mild/severe forms from other disease • - AP/Lat standing or AP/stress dorsiflex lat films • E. Treatment • Non-surgical • - weekly serial manipulation and casting • - must follow certain order of correction • - success rate 15-80% • Surgical • - majority do well; calf and foot is smaller

  14. Talipes Equinovarus (congenital clubfoot)

  15. Metatarsus Adductus

  16. Metatarsus adductus - medial deviation of all metatarsals with normal relationship between talus and calcaneus.

  17. Metatarsus Adductus • Essentially forefoot varus • Etiology - result of the infant's position inside the uterus • Frequency – 1 to 2 /1000 live births

  18. Metatarsus Adductus Tx • Treatment depends on the severity of the deformity • 85 to 90% resolve by 1 year of age • 4% remain at 16 years of age • Mild (flexible, passively correctable) MTA requires only parental reassurance • Moderate (semi-flexible, reducible) MTA can be treated with stretching exercises at every diaper change • heel is stabilized within the notch between the thumb and index finger • the forefoot is slightly pulled distally, held between the thumb and index finger of the other hand, and gently pushed into a corrected position • Severe (rigid) MTA can be referred for serial casting and bracing. Evidence-based comparisons of splinting or casting versus manipulation alone are not yet available

  19. Pes Planus (flatfoot) • General • - refers to loss of normal medial long. arch • - usually caused by subtalar joint assuming an • everted position while weight bearing • - generally common in neonates/toddlers • B. Evaluation • - painful? • - flexible? (hindfoot should invert/dorsiflex • approx 10 degrees above neutral • - arch develop with non-weight bearing pos?

  20. Pes Planus (flatfoot)

  21. Pes Planus (flatfoot) C. Treatment (i) Flexible/Asymptomatic - no further work up/treatment is necessary! - no studies show flex flatfoot has increased risk for pain as an adult (ii) rigid/painful - must r/o tarsal coalition – congenital fusion or failure of seg. b/w 2 or more tarsal bones - usually assoc with peroneal muscle spasm - need AP/lat weight bearing films of foot

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