Paediatric Foot Disorders - HEE foot disorders - B Milne.pdf · Foot Disorders CLAW TOE Flexion...
Transcript of Paediatric Foot Disorders - HEE foot disorders - B Milne.pdf · Foot Disorders CLAW TOE Flexion...
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Foot Disorders
Paediatric Foot Disorders
B Milne B Milne FRACS (Orth)FRACS (Orth)
Paediatric Orthopaedic FellowPaediatric Orthopaedic Fellow
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Foot Disorders
Anatomy
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Foot Disorders
Bones of the foot
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Foot Disorders
Valgus
Deviation of the distal body part away from the midline
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Foot Disorders
Varus
Deviation of the distal body part towards the midline
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Foot Disorders
Adduction
Movement of forefoot towards the midline
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Foot Disorders
Abduction
Movement of forefoot away from the midline
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Foot Disorders
Inversion
deviation of foot medially at the subtalar joint
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Foot Disorders
Eversion
deviation of foot laterally at the subtalar joint
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Foot Disorders
Plantarflexion
deviation of foot downwards at the ankle joint
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Foot Disorders
Dorsiflexion
deviation of foot upwards at the ankle joint
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Foot Disorders
Pronation
Combined dorsiflexion, eversion and abduction
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Foot Disorders
Supination
Combined plantarflexion, inversion and adduction
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Foot Disorders
Cavus
elevated longitudinal arch of the foot
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Foot Disorders
Planus
flattened longitudinal arch of the foot
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Foot Disorders
Calcaneus
extreme dorsiflexion deformity of the hindfoot
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Foot Disorders
Equinus
extreme plantarflexion deformity of the hindfoot
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Foot Disorders
Congenital Talipes Equinovarus
Also known as Clubfoot Also known as Clubfoot
Characterised by deformity CAVECharacterised by deformity CAVE
–– Cavus of the midfoot archCavus of the midfoot arch
–– Adduction of the forefootAdduction of the forefoot
–– Varus of the hindfootVarus of the hindfoot
–– Equinus of the hindfootEquinus of the hindfoot
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Foot Disorders
CTEV
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Foot Disorders
Incidence
UsualUsual 1 per 1,000 1 per 1,000
M:F M:F 2.5 : 12.5 : 1
Bilateral Bilateral 50%50%
MaorisMaoris 7 per 1,0007 per 1,000
RiskRisk 22--5% in siblings5% in siblings
25% if both parent 25% if both parent
and sibling affectedand sibling affected
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Foot Disorders
NeurologicalNeurological
–– MyelomeningoceleMyelomeningocele
–– Spina bifida occultaSpina bifida occulta
Arthrogryposis Congenita MultiplexArthrogryposis Congenita Multiplex
Chromosome AbnormalitiesChromosome Abnormalities
–– Trisomy 13 & 18Trisomy 13 & 18
Associated conditions
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Foot Disorders
Aetiology UnknownUnknown
TheoriesTheories
–– Packaging defect (Packaging defect (HippocratesHippocrates) )
–– Neuromuscular defect Neuromuscular defect
–– Reduced anterior horn cells (Reduced anterior horn cells (SwartSwart))
–– Increase in type I (slow) fibresIncrease in type I (slow) fibres
–– Arrest of foetal developmentArrest of foetal development
–– Primary germ plasm defect of talusPrimary germ plasm defect of talus
–– Retracting fibrosisRetracting fibrosis
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Foot Disorders
Diagnosis
Prenatal Prenatal
UltrasoundUltrasound
Structural Structural
PosturalPostural
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Foot Disorders
Treatment
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Foot Disorders
Ponseti
Serial casting to Serial casting to
correct deformitycorrect deformity
Often requires Often requires
achilles tendon achilles tendon
tenotomy to tenotomy to
correct equinuscorrect equinus
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Foot Disorders
Ponseti - Boots and Bars
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Foot Disorders
Relapse
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Foot Disorders
Surgery
Staged surgeryStaged surgery
Posteromedial Posteromedial
releaserelease
Posterolateral Posterolateral
releaserelease
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Foot Disorders
Relapse
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Foot Disorders
Congenital Talipes
Calcaneovalgus
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Foot Disorders
CALCANEOVALGUS
FOOT 1:1000 live births1:1000 live births
Intrauterine PositioningIntrauterine Positioning
Associated with lateral tibial torsionAssociated with lateral tibial torsion
Common in first bornCommon in first born
Dorsiflexion/eversion/abductionDorsiflexion/eversion/abduction
Passively correctablePassively correctable
Resolves spontaneously Resolves spontaneously -- passive stretches & passive stretches &
splints may be usedsplints may be used
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Foot Disorders
METATARSUS
ADDUCTUS
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Foot Disorders
METATARSUS
ADDUCTUS
1:1000 incidence1:1000 incidence
50% bilateral50% bilateral
Results from intrauterine positionResults from intrauterine position
Forefoot adducted at TMT joint, Forefoot adducted at TMT joint,
sole is kidney shaped, heel is NOT sole is kidney shaped, heel is NOT
equinusequinus
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Foot Disorders
METATARSUS
ADDUCTUS
86% resolve spontaneously by age 86% resolve spontaneously by age
6, 95% by age 16.6, 95% by age 16.
1010--15% also have DDH15% also have DDH
Medial skin crease suggestive of Medial skin crease suggestive of
resistant caseresistant case
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Foot Disorders
Metatarsus Adductus
Grading System Grade IGrade I
–– OvercorrectsOvercorrects
Grade IIGrade II
–– Corrects to neutralCorrects to neutral
Grade IIIGrade III
–– Does not correct to neutralDoes not correct to neutral
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Foot Disorders
Metatarsus Adductus
Treatment
CorrectableCorrectable
–– No treatmentNo treatment
Not correctableNot correctable
–– Serial castingSerial casting
–– ?straight medial border shoes?straight medial border shoes
Not correctable and symptomaticNot correctable and symptomatic
–– ? Surgery? Surgery
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Foot Disorders
Metatarsus Adductus
Long term results of patients with Long term results of patients with
mildmild--moderate residual deformity moderate residual deformity
after treatment are good.after treatment are good.
SURGERY indicated in children SURGERY indicated in children
>5yo with severe symptomatic >5yo with severe symptomatic
residual metatarsus adductus. residual metatarsus adductus.
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Foot Disorders
Surgical treatment
Metatarsus Adductus
Adductor Adductor
Hallucis releaseHallucis release
Medial opening Medial opening
cuneiform and cuneiform and
lateral closing lateral closing
cuboid cuboid
osteotomiesosteotomies
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Foot Disorders
Skewfoot
Combination of Combination of
forefoot forefoot
deformity of deformity of
metatarsus metatarsus
adductus and adductus and
hindfoot hindfoot
deformity of deformity of
valgus flatfootvalgus flatfoot
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Foot Disorders
Skewfoot
RareRare
Aetiology unknown Aetiology unknown
–– ? iatrogenic? iatrogenic
–– ? muscle imbalance? muscle imbalance
–– often syndromaloften syndromal
Natural history unknown ? Natural history unknown ?
–– Little evidence of disabilityLittle evidence of disability
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Foot Disorders
Skewfoot
Symptoms: Pain over talar head, 1st MT Symptoms: Pain over talar head, 1st MT
head, 5th MT basehead, 5th MT base
Treatment in young children:Treatment in young children:
Serial casts as for metatarsus adductus Serial casts as for metatarsus adductus
with varus stress on heelwith varus stress on heel
Aim to convert foot to flatfootAim to convert foot to flatfoot
Treatment in older children: osteotomies Treatment in older children: osteotomies
of the calcaneus and midfootof the calcaneus and midfoot
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Foot Disorders
Pes Cavus
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Foot Disorders
PES CAVUS
Elevated longitudinal arch due to Elevated longitudinal arch due to
plantar flexion of the forefoot &/or plantar flexion of the forefoot &/or
dorsiflexion of the calcaneus.dorsiflexion of the calcaneus.
Secondary contracture of plantar Secondary contracture of plantar
fascia.fascia.
Claw toes Claw toes -- often the first deformity often the first deformity
seen.seen.
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Foot Disorders
Cavus Foot - Aetiology
> 50% > 50% NeuromuscularNeuromuscular
Hereditary Motor Sensory Neuropathy (CMT)Hereditary Motor Sensory Neuropathy (CMT)
PoliomyelitisPoliomyelitis
Friedreich’s ataxiaFriedreich’s ataxia
Cerebral PalsyCerebral Palsy
Spina bifidaSpina bifida
Spinal cord tumourSpinal cord tumour
SyringomyeliaSyringomyelia
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Foot Disorders
Cavus Foot - Aetiology
Non neurological causes include:Non neurological causes include:
–– IdiopathicIdiopathic
–– CTEV, ArthrogryposisCTEV, Arthrogryposis
–– TraumaticTraumatic
Compartment SyndromeCompartment Syndrome
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Foot Disorders
Cavovarus
Plantarflexion of first rayPlantarflexion of first ray
Pronation of forefootPronation of forefoot
Adduction of forefootAdduction of forefoot
Hindfoot varusHindfoot varus
Toes clawedToes clawed
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Foot Disorders
Cavus foot symptoms
Clawtoes Clawtoes -- calluses with shoescalluses with shoes
MetatarsalgiaMetatarsalgia
High archHigh arch
Anterior ankle painAnterior ankle pain
Recurrent ankle sprainsRecurrent ankle sprains
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Foot Disorders
Cavus Treatment
Full neurologic workFull neurologic work--up especially if up especially if
unilateralunilateral
–– Spinal XSpinal X--Rays Rays
–– MRIMRI
–– NCSNCS
Referral to neurologistReferral to neurologist
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Foot Disorders
Cavovarus foot - treatment
NonNon--operative operative orthotics orthotics
Surgery : Plantar release, dorsal Surgery : Plantar release, dorsal
cuneiform osteotomycuneiform osteotomy
–– Tendon tranfersTendon tranfers
–– Calcaneal osteotomyCalcaneal osteotomy
–– Ilizarov for multiply operated caseIlizarov for multiply operated case
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Foot Disorders
CONGENITAL VERTICAL
TALUS
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Foot Disorders
Congenital Vertical Talus
Irreducible dorsal dislocation of Irreducible dorsal dislocation of
navicular on talus with a fixed navicular on talus with a fixed
talocalcaneal complex. Dislocation talocalcaneal complex. Dislocation
can be limited to talonavicular joint can be limited to talonavicular joint
or can also involve calcaneocuboid or can also involve calcaneocuboid
joint.joint.
Common cause of rigid flatfootCommon cause of rigid flatfoot
50% bilateral50% bilateral
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Foot Disorders
Congenital Vertical Talus
Teratologic Teratologic -- most CVTmost CVT
–– Chromosomal abnormalitiesChromosomal abnormalities
–– ArthrogryposisArthrogryposis
–– MyelomeningocoeleMyelomeningocoele
NeurogenicNeurogenic
Iatrogenic Iatrogenic -- overcorrection CTEVovercorrection CTEV
Idiopathic Idiopathic -- rarerare
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Foot Disorders
NORMAL OBLIQUE TALUS VERTICAL TALUS
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Foot Disorders
CVT TREATMENT
NonNon--operative initiallyoperative initially
–– stretchingstretching
–– serial castingserial casting
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Foot Disorders
CVT - SURGERY
Surgery is aimed at correcting Surgery is aimed at correcting
hindfoot equinus and forefoot hindfoot equinus and forefoot
dorsiflexion and abductiondorsiflexion and abduction
Correction of hindfoot is the Correction of hindfoot is the
primary step in correction of the primary step in correction of the
footfoot
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Foot Disorders
OBLIQUE TALUS
Talonavicular subluxation that reduces Talonavicular subluxation that reduces
with plantar flexion of the foot.with plantar flexion of the foot.
Treatment Treatment
–– ObservationObservation
–– OrthoticsOrthotics
–– Sugery: Pinning reduced talonavicular Sugery: Pinning reduced talonavicular
joint & tendoachilles lengtheningjoint & tendoachilles lengthening
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Foot Disorders
TARSAL COALITION
Disorder of mesenchymal segmentation Disorder of mesenchymal segmentation
leading to fusion of 2 or more tarsal leading to fusion of 2 or more tarsal
bonesbones
Autosomal dominant with variable Autosomal dominant with variable
penetrancepenetrance
3% of population3% of population
50% bilateral50% bilateral
90% calcaneonavicular or talocalcaneal90% calcaneonavicular or talocalcaneal
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Foot Disorders
TARSAL COALITION
May be bony, cartilaginous or fibrousMay be bony, cartilaginous or fibrous
Multiple coalitions may exist in same Multiple coalitions may exist in same
footfoot
Leading cause of peroneal spastic Leading cause of peroneal spastic
flatfootflatfoot
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Foot Disorders
TARSAL COALITION
Become symptomatic when coalition Become symptomatic when coalition
ossifies:ossifies:
Hindfoot pain aggravated by activity. Hindfoot pain aggravated by activity.
Ankle sprainsAnkle sprains
Stiff subtalar jointStiff subtalar joint
Medial or lateral tendernessMedial or lateral tenderness
Peroneal spastic flatfootPeroneal spastic flatfoot
TALONAVICULAR 3-5yo
CALCANEONAVICULAR 8-12yo
TALOCALCANEAL 12-16yo
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Foot Disorders
Normal oblique foot xray
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Foot Disorders
CALCANEO-
NAVICULAR
BAR
ANTEATER’S
NOSE
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Foot Disorders
TALONAVICULAR
COALITION
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Foot Disorders
TARSAL COALITION
Asymptomatic Asymptomatic -- observationobservation
Symptomatic: NONSymptomatic: NON--OPERATIVE OPERATIVE
–– activity modificationactivity modification
–– OrthoticsOrthotics
–– Short leg walking castShort leg walking cast
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Foot Disorders
TARSAL COALITION
OPERATIVE TREATMENTOPERATIVE TREATMENT
–– Calcaneonavicular Calcaneonavicular -- excision & EDB interpositionexcision & EDB interposition
–– TalocalcanealTalocalcaneal
adolescent with <50% of facet involved adolescent with <50% of facet involved -- resectionresection
subtalar OA or > 50% of facet involved subtalar OA or > 50% of facet involved -- subtalar fusion subtalar fusion
midfoot OA midfoot OA -- triple arthrodesistriple arthrodesis
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Foot Disorders
Juvenile Hallux Valgus
Bunion
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Foot Disorders
JUVENILE BUNION
Bilateral, familial, more common in Bilateral, familial, more common in
femalesfemales
Aetiology: Imbalance of forcesAetiology: Imbalance of forces
Predisposing factors:Predisposing factors:
Metatarsus primus varusMetatarsus primus varus
Long 1st MTLong 1st MT
Ligamentous laxityLigamentous laxity
Neurologic disordersNeurologic disorders
Shoewear with narrow toe boxShoewear with narrow toe box
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Foot Disorders
JUVENILE BUNION Most asymptomatic & require no Most asymptomatic & require no
treatmenttreatment
NonNon--operative treatment: wide shoes operative treatment: wide shoes
and arch supportand arch support
Surgical treatment Surgical treatment -- progression of progression of
deformity or failed nondeformity or failed non--op txop tx
SOFT TISSUE CORRECTION
OSTEOTOMY - metatarsal
- phalangeal
- cuneiform
ARTHRODESIS
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Foot Disorders
JUVENILE BUNION
ComplicationsComplications
* OVERCORRECTION/HALLUX VARUS
* RECURRENCE 20% (soft tissue only >50%)
- inversely related to age
REOPERATE AFTER SKELETAL MAT
* PHYSEAL INJURY - rare
* AVN - rare
* STIFFNESS
* DEFUNCTIONING 1ST RAY
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Foot Disorders
BUNIONETTE Lateral prominence Lateral prominence
of 5th MT headof 5th MT head
Usually unilateralUsually unilateral
Irritated by shoewearIrritated by shoewear
Treatment:Treatment:
–– NonNon--operativeoperative
shoewear modificationshoewear modification
–– OperativeOperative
ExostectomyExostectomy
osteotomyosteotomy
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Foot Disorders
Flexible Flatfoot
Flattening of the Flattening of the
medial longitudinal medial longitudinal
arch on standingarch on standing
Heel valgus, forefoot Heel valgus, forefoot
pronation and pronation and
abduction.abduction.
Prominent talar head Prominent talar head
medially.medially.
7%7%--22% prevalence22% prevalence
Bilateral and familialBilateral and familial
Associated with Associated with
ligamentous laxity ligamentous laxity
and limb alignment and limb alignment
problemsproblems
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Foot Disorders
Flexible Flatfoot
Symptoms: midfoot ache, pretibial pain, Symptoms: midfoot ache, pretibial pain,
excessive shoe wear. Pain and callosity excessive shoe wear. Pain and callosity
over talar head.over talar head.
Longitudinal arch develops spontaneously Longitudinal arch develops spontaneously
during first decade and most flatfooted during first decade and most flatfooted
adults are asymptomatic.adults are asymptomatic.
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Foot Disorders
Flexible Flatfoot
No treatment if asymptomaticNo treatment if asymptomatic
If symptomatic If symptomatic
–– Arch orthosis/UCBL insertsArch orthosis/UCBL inserts
–– Achilles tendon stretches if tightAchilles tendon stretches if tight
If refractory If refractory
–– wedge or sliding calcaneal osteotomy wedge or sliding calcaneal osteotomy
–– +/+/-- Achilles tendon lengtheningAchilles tendon lengthening
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Foot Disorders
KOHLER’S DISEASE
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Foot Disorders
KOHLER’S DISEASE
AVN of navicular due to repetitive AVN of navicular due to repetitive compressive forcescompressive forces
Males (5:1) Males (5:1)
4 4 -- 5 yo5 yo
Bilateral in 1/3Bilateral in 1/3
Self limitingSelf limiting
XX--Ray Ray -- flattening, sclerosis, flattening, sclerosis, irregularity of navicularirregularity of navicular
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Foot Disorders
KOHLER’S DISEASE
May be asymptomaticMay be asymptomatic
Present with pain over navicular, Present with pain over navicular, antalgic gait, weight bearing on antalgic gait, weight bearing on lateral aspect of footlateral aspect of foot
Treat with decreased activity, Treat with decreased activity, orthotics with arch support +/orthotics with arch support +/--immobilisationimmobilisation
Prognosis excellentPrognosis excellent
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Foot Disorders
FREIBERG’S INFRACTION
AVN usually of 2nd MT head (other MTs AVN usually of 2nd MT head (other MTs may be affected) due to vascular may be affected) due to vascular insufficiency 2insufficiency 200 to chronic stress to chronic stress
AdolescentsAdolescents
Female 75%Female 75%
Occasionally Occasionally
bilateralbilateral
XX--Ray: MT head flat & Ray: MT head flat & irregularirregular
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Foot Disorders
FREIBERG’S INFRACTION
Metatarsalgia, mild swelling and Metatarsalgia, mild swelling and stiffnessstiffness
Treatment: Treatment:
–– nonnon--operativeoperative Walking castWalking cast
Metatarsal padMetatarsal pad
–– OperativeOperative curettage & bone graftcurettage & bone graft
Shortening MT osteotomyShortening MT osteotomy
extension osteotomyextension osteotomy
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Foot Disorders
SEVER’S DISEASE
Traction apophysitis at insertion of Traction apophysitis at insertion of
Achilles tendonAchilles tendon
Heel pain & tenderness, aggravated by Heel pain & tenderness, aggravated by
activity & relieved by restactivity & relieved by rest
Decreased ankle dorsiflexionDecreased ankle dorsiflexion
Normal XNormal X--Rays Rays -- sclerosis and sclerosis and
fragmentation of calcaneal apophysis fragmentation of calcaneal apophysis
normal variantnormal variant
Treatment: Activity modification, rest, Treatment: Activity modification, rest,
heel cushion, stretches, NSAIDS, castheel cushion, stretches, NSAIDS, cast
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Foot Disorders
SEVER’S DISEASE OR
NORMAL ?
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Foot Disorders
ACCESSORY NAVICULAR
Normal variant seen in 4Normal variant seen in 4--21%21%
Often incidental discovery Often incidental discovery
Associated with flatfeetAssociated with flatfeet
Medial arch pain with overuse Medial arch pain with overuse
centred over navicular.centred over navicular.
External oblique XExternal oblique X--Ray view Ray view
demonstratesdemonstrates
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Foot Disorders
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Foot Disorders
ACCESSORY NAVICULAR
Treated with restriction of activities Treated with restriction of activities
+/+/-- immobilisation in short leg cast, immobilisation in short leg cast,
then shoe modification/padding then shoe modification/padding
Excision relieves pain but does not Excision relieves pain but does not
correct flatfootcorrect flatfoot
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Foot Disorders
CURLY TOE
“Underlapping toe”. “Underlapping toe”. Flexion deformity of Flexion deformity of PIP jt with external PIP jt with external rotation and varus of rotation and varus of the toe.the toe.
Usually occurs in Usually occurs in lateral 3 toeslateral 3 toes
Familial, bilateral, Familial, bilateral, symmetrical, rarely symmetrical, rarely symptomaticsymptomatic
Due to muscle Due to muscle imbalanceimbalance
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Foot Disorders
CURLY TOE
25% resolve spontaneously. 25% resolve spontaneously. Remainder don’t worsen with Remainder don’t worsen with growth but may develop symptoms growth but may develop symptoms and become stiff.and become stiff.
Treatment if symptomatic or if Treatment if symptomatic or if severe severe -- flexor tenotomyflexor tenotomy (FDL +/(FDL +/--FDB)FDB)
Late treatment Late treatment -- resection or resection or arthrodesis of PIP joint may be arthrodesis of PIP joint may be necessary for correctionnecessary for correction
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Foot Disorders
OVERLAPPING
FIFTH TOE
Familial, bilateral & Familial, bilateral &
asymptomatic asymptomatic
Fifth toe adducted, extended & externally Fifth toe adducted, extended & externally rotated at MTP jt & overlaps fourth toerotated at MTP jt & overlaps fourth toe
May cause footwear problemsMay cause footwear problems
NonNon--operative tx: stretching & buddy tapingoperative tx: stretching & buddy taping
Operative Operative -- tenotomy, dorsal capsulotomy & tenotomy, dorsal capsulotomy & VV--Y advancementY advancement
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Foot Disorders
OLIGODACTYLY
Congenital absence of toe(s)Congenital absence of toe(s)
Requires no treatmentRequires no treatment
Associated with fibular hemimelia Associated with fibular hemimelia
and tarsal coalitionand tarsal coalition
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Foot Disorders
TOE POLYDACTYLY
Extra digits Extra digits -- preaxial, central or preaxial, central or
postaxialpostaxial
Incidence 2:1000Incidence 2:1000
Usually involves lateral ray (80%)Usually involves lateral ray (80%)
May be inherited (30%) (AD)May be inherited (30%) (AD)
25% bilateral25% bilateral
Associated with finger polydactyly & Associated with finger polydactyly &
metatarsal anomaliesmetatarsal anomalies
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Foot Disorders
TOE POLYDACTYLY
Rudimentary digits treated by ligation in Rudimentary digits treated by ligation in
nursery and allowing “autoamputation”nursery and allowing “autoamputation”
Surgical excision of digit at 9Surgical excision of digit at 9--12 months 12 months
before starts wearing shoesbefore starts wearing shoes
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Foot Disorders
TOE SYNDACTYLY
Fusion of adjacent toes (2ndFusion of adjacent toes (2nd--3rd)3rd)
Familial & asymptomaticFamilial & asymptomatic
Simple or ComplexSimple or Complex
Complete or partialComplete or partial
Simple does not require treatmentSimple does not require treatment
Complex separated at 18mths Complex separated at 18mths -- 5yrs.5yrs.
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Foot Disorders
HAMMER
CLAW
MALLET
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Foot Disorders
HAMMER TOE
Flexion deformity at PIP jt with hyperextension at DIP Flexion deformity at PIP jt with hyperextension at DIP
jt +/jt +/-- secondary hyperextension at MTP jt.secondary hyperextension at MTP jt.
Due to flexor tightnessDue to flexor tightness
Bilateral, symmetrical, commonly 2nd toe.Bilateral, symmetrical, commonly 2nd toe.
Asymptomatic early Asymptomatic early -- later painful corn, stiffnesslater painful corn, stiffness
Treatment flexor tenotomy in early childhood Treatment flexor tenotomy in early childhood
Fixed deformity Fixed deformity -- arthrodesis PIPJ + MTPJ dorsal arthrodesis PIPJ + MTPJ dorsal
capsular releasecapsular release
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Foot Disorders
CLAW TOE
Flexion deformity at PIP and DIP jts with Flexion deformity at PIP and DIP jts with
hyperextension at MTP jthyperextension at MTP jt
Usually all 4 lesser toes involvedUsually all 4 lesser toes involved
Usually assoc with pes cavus but can be Usually assoc with pes cavus but can be
idiopathicidiopathic
Result of imbalance between intrinsics and Result of imbalance between intrinsics and
extrinsics musclesextrinsics muscles
Often asymptomatic.Often asymptomatic.
Symptoms Symptoms -- metatarsalgia, painful corns over metatarsalgia, painful corns over
PIP jtsPIP jts
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Foot Disorders
CLAW TOE
Treatment:Treatment:
–– NonNon--operativeoperative
shoewear modification (deep toe box, soft shoes)shoewear modification (deep toe box, soft shoes)
Orthotics Orthotics -- metatarsal barmetatarsal bar
–– Operative Operative --
Capsule releaseCapsule release
TenotomyTenotomy
Tendon transferTendon transfer
Arthrodesis PIPJArthrodesis PIPJ
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Foot Disorders
MALLET TOE
Flexion deformity at DIP jtFlexion deformity at DIP jt
Aetiology: FDL shorteningAetiology: FDL shortening
Commonly 2nd toeCommonly 2nd toe
Assoc with long 2nd MTAssoc with long 2nd MT
Symptoms from dorsal corn or toenail irritationSymptoms from dorsal corn or toenail irritation
Treatment: Treatment:
–– young child young child -- FDL tenotomy FDL tenotomy
–– fixed deformity fixed deformity -- excision arthroplasty or arthrodesisexcision arthroplasty or arthrodesis
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Foot Disorders
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