Pediatric Foot Deformities - Pediatric - Lecture Slides, Slides of Pediatrics

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Common Pediatric Foot Deformities

Anatomy/Terminology

• 3 main sections 1.Hindfoot – talus, calcaneus 2.Midfoot – navicular, cuboid, cuneiforms 3.Forefoot – metatarsals and phalanges

Anatomy/Terminology

• Varus/Valgus

Calcaneovalgus foot

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)

Talipes Equinovarus (congenital clubfoot)

A. General

• complicated, multifactorial deformity of primarily genetic origin
• 3 basic components (i) ankle joint plantarflexed/equines (ii) subtalar joint inverted/varus (iii) forefoot adducted

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

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

Pes Planus (flatfoot)

A. 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?

Pes Planus (flatfoot)

In-Toeing

A. General

• common finding in newborns and children
• little evidence to show benefit from treatment

In-Toeing

B. Evaluation

• family hx of rotational deformity?
• pain?
• height/weight normal?
• limited hip abduct or leg length discrepancy?
• neuro exam

C. 3 main causes (i) metatarsus adductus (ii) internal tibial torsion (iii) excessive femoral anteversion

In-Toeing

(i) metatarsus adductus

• Evaluation
  • should have normal ankle motion
  • assess flexibility by holding heel in neutral position, abducting forefoot

In-Toeing

(i) metatarsus adductus

• treatment
  • if flexible, stretching; Q diaper change, 10 sec
  • if rigid, or if no resolution by 4-8 months, refer to ortho
  • prognosis is good: 85-90% resolve by 1yr