6760175
Description
Flashcards by Louise Weir, updated more than 1 year ago
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Created by Louise Weir
over 7 years ago
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| Question | Answer |
| What are the 3 classifications of foot deformity? | Structural Postural Acquired |
| Common causes of structural deformity | When: early gestation (0-8 weeks) Due to: Teratological (congenital defect) Idiopathic (no known cause) Common Pathologies: Arthrogryposis (fixed deformity) Congenital Talipes Equinovarus (Clubfoot) |
| Common causes of postural deformity | When: late gestation (3rd Trimester) Due to: Moulding / Packaging (in utero) Common Pathologies: Torticollis DDH MTA |
| Common causes of acquired deformity | When: infancy and childhood Due to: Altered intermittent forces Common pathologies: Cerebral Palsy Spina Bifida DMD |
| Coupling position of heel = position of mid-foot | heel valgus = mid-foot eversion (DF + Abdn + Pron) heel varus = mid-foot inversion (PF + Addn + Sup) |
| Terminology Talipes Pes Equinus Calcaneus Valgus Varus | Talipes: Talus (Ankle) Pes (Foot) Pes: Foot Equinus: posn of foot into PF (toe-walking) Calcaneus: heel Valgus: angled away from midline Varus: angled towards midline |
| Calcaneo Valgus (Postural) | Packaging deformity usually resolves by itself over a few months Ax: increased DF on PROM Rx: stretching for tight anterior structures |
| Calcaneo Valgus (Acquired) | Spina Bifida Cerebral Palsy Ax: decreased muscle tone Rx: stretching, casting, surgery |
| Congenital Vertical Talus (Rocker Bottom Foot) | Structural deformity assoc w other abnormalities i.e. arthrogryposis Ax: severe rigid deformity Talus - PF Hindfoot - Equinus Navicular dislocated on Talus early ID and ref to ortho sx / serial casting w care++++ Rx: referral 1st - stretching/casting may worsen/stretch other structures - follow post op instructions |
| Metatarsus Adductus (Dynamic Great Toe) | Packaging deformity High assoc w DDH + Torticollis Ax: medial deviation (addn) of MT (forefoot), curved lat border of foot (kidney shaped), normal hindfoot and mid-foot Rx: stretching, serial casting. splinting, surgery (post 4 yrs of age as may spontaneously correct) Note: If MTA not resolving suspect Skew Foot |
| Metatarsus Adductus (Dynamic Great Toe) Classification | Classification (according to how correctable the addn is): - normal (plum line = heel thru 2nd toe) - mild (plum line = heel thru 3rd toe) - mod (plum line = heel thru 3rd/4th toe) - severe (plum line = heel thru 4th/5th toe) |
| Skew Foot | Structural deformity Ax: MT bones turned in, 1st cuneiform more triangular than square, hindfoot is in valgus Rx: surgery - tighten ligs, cut bone, pins + casts to re-align bone Goal: to allow flexible foot for footwear |
| Congenital Talipes Equinovarus (CTEV) (Clubfoot) What types of deformity? | Structural deformity - involves the bone and joints of the foot, where the child's foot cannot be passively put through a full range of motion. Postural deformity - involves muscle imbalance and / or tightness. There is usually no bone or joint involvement. |
| CTEV Clinical Presentation 1 | Requires specialist management affected calf is smaller foot = cavus midfoot = PF + Addn + Supn heel = varus hindfoot = equinus |
| CTEV Clinical Presentation 2 | affected foot is smaller 1st MT is in PF bones mal-aligned navicular dislocated or subluxed on talus cuboid subluxed on calcaneum calcaneum inverted and PF |
| CTEV Ax Pirani Severity Score | 6 clinical signs (3 x hindfoot / 3 x forefoot) - max score = 6 (high score = high sev) (0 = no abnormality) (0.5 = moderate abnormality) (1 = severe abnormality) feet are scored after each change of plaster |
| CTEV Ax Pirani Severity Score Midfoot vs Hindfoot Contracture | Midfoot Contracture - curvature of the lateral border of foot - medial crease (med arch shape) - lateral part of the head of talus Hindfoot Contracture - posterior crease (back of heel) - empty heel (on palpn of calcaneus) - rigid equinus (knee extn, supn, DF) |
| CTEV Sx Ponseti Technique - 90% success rate early intervention = increased efficacy Goals of Rx | function flexibility pain free strength "normal looking" ROM to plantargrade ability to wear normal shoes |
| CTEV Sx Ponseti Technique Stages of Rx | Stage 1 - Manipulation + Serial Casting - at around 5-6 weeks - correct cavus, varus and eversion Stage 2 - Tenotomy (lengthening) and casting - occurs over the next 2 to 3 weeks - correct the rigid equinus Stage 3 - Achilles tendon lengthening - corrects the rigid equinus |
| CTEV Sx When is achilles tendon lengthening indicated? | if abdn is > 70 degrees heel is in valgus then: re-cast over 3 weeks |
| CTEV Sx Bracing - aim? - fitting? - how long? | is an essential, but hardest part of Rx holds the foot in the correct position shoes fitted to bar: - 70 deg for affected foot - 45 deg for non-affected foot - 10-15 deg of DF (slight bend in bar) bar length = shoulder width 23 hours per day for 3 months, then 14 hours per day for 4 years (with reg monitoring over 4 years) |
| CTEV Sx Ponseti Technique 1. Why may a relapse occur? 2. What Rx following relapse? | 1. poor follow up muscle imbalance incorrect or insufficient correction 2. re-cast and brace Tibialis Anterior tendon transfer (sec. to muscle imbalance) |
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