A case report of bilateral mirror feet with varus deformity.

OBJECTIVES: To describe a rare case of bilateral mirror feet with varus deformity and review of literature. METHODS: AP and oblique radiographs of both feet were taken. RESULTS: On radiographs, right foot showed eight toes and seven metatarsals while left foot showed eight toes and seven metatarsals, the three extra toes were present preaxially (on hallux side) in both feet, showing characteristics of postaxial toes termed as "mirror foot". Varus deformity was noted at the subtalar joint, otherwise tarsal bones appeared normal. No any syndromatic association was present. CONCLUSION: Mirror foot is a very rare congenital anomaly, we put forward this case for its rarity and unusual late presentation at the age of 22.

Management of Hallux Valgus in Metatarsus Adductus.

Metatarsus adductus is common clinical entity with an estimated prevalence of approximately 30%. Multiple radiographic methods exist to evaluate the extent of the deformity, with the Sgarlato and Engel methods most commonly used. Surgical treatment varies, consisting of proximal versus distal metatarsal osteotomies, TMT arthrodesis, and realignment of the lesser rays. Particularly in severe cases, addressing all deformities is critical to obtaining a good outcome.

In-toeing gait in children with clubfoot and the effect of tibial rotation osteotomy.

In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to characterize the gait pattern in children with an intoeing gait pattern associated with talipes equinovarus (TEV) deformity, identify secondary changes at the hip that occur with intoeing, and determine if these secondary effects resolve after correction of tibial torsion. Patients with a diagnosis of TEV deformity, in-toeing gait secondary to residual internal tibial torsion corrected with tibial rotation osteotomy (TRO) and complete preoperative and postoperative motion analysis studies obtained approximately 1 year apart, were included in the study. Nineteen children (19 left extremities) with a TRO at a mean age of 8.2 years met inclusion criteria. Clinical examination showed improvement in tibial torsion assessment by measure of the thigh foot axis and transmalleolar axis. Kinematically, an abnormal internal FPA was present in all cases preoperatively, was corrected to normal in 12 (63%), remained internal in 5 (26%), and was abnormally external in 2 (11%). External hip rotation was identified in 13 (68%) cases preoperatively. Hip rotation was normalized postoperatively in 7 (54%), and was unchanged in the remaining 6 (46%). TRO provides effective correction of excessive internal tibial torsion, resolution of kinematic internal knee rotation, and normalization of the internal foot progression angle in the majority of patients with TEV deformity. External hip rotation resolved in approximately 50% of cases. Overcorrection of the internal FPA is possible when secondary changes at the hip do not resolve.

The identification and appraisal of assessment tools used to evaluate metatarsus adductus: a systematic review of their measurement properties.

BACKGROUND: Metatarsus adductus is the most common congenital foot deformity in newborns. It involves adduction of the metatarsals at the Lisfranc joint. A systematic literature review was conducted to investigate the following question: What tools are used to identify and quantify metatarsus adductus and how reliable, valid and responsive are they? METHODS: The following electronic databases were searched for studies describing tools for the identification and quantification of metatarsus adductus in adults and children published from inception to June 2016: Ovid MEDLINE, Embase, CINAHL, Scopus, Web of Science and AMED. Two researchers initially searched all articles by screening titles and abstracts. If there was any doubt as to an article's eligibility, the full text paper was retrieved. Reference lists and citations of all retained studies were examined in an attempt to locate further studies. Articles were excluded if they were not in English or described other congenital foot conditions that did not include metatarsus adductus. Studies included in the review reporting measurement properties of measurement tools were critically appraised using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) critical appraisal tool. RESULTS: There were 282 articles screened by title and abstract and 28 articles screened from full text. Fifteen articles were included and nine had data that were extractable for appraisal using the COSMIN critical appraisal tool. Techniques to measure metatarsus adductus included the heel bisector method, photocopies, ultrasound, footprints, dynamic foot pressure and radiographs. There was a paucity of quality data reporting the reliability, validity or responsiveness for measuring metatarsus adductus. Several radiographic angles showed good reliability (intraclass correlation (ICC) - 0.84, 0.97) in adults during pre-operative planning. CONCLUSION: There have been multiple assessment techniques proposed for quantification of metatarsus adductus, but there is paucity of reliability, validity or responsiveness to measurement data about these techniques, especially in relation to the paediatric population. Further consideration of measurement testing is required to determine if the most common non-radiographic measures of metatarsus adductus are acceptable for clinical use.

Combined Medial Cuneiform Osteotomy and Multiple Metatarsal Osteotomies For Correction of Persistent Metatarsus Adductus in Children.

BACKGROUND: Metatarsus adductus may occur in children after otherwise successful clubfoot treatment or may be an isolated deformity. There are various bony procedures currently in use for treatment of this problem. The purpose of this study was to review our experience with medial cuneiform opening-wedge osteotomy along with transmetatarsal osteotomy through the base of the second to fifth for treatment of the forefoot adductus in children. METHODS: From 1992 to 2008, we found 16 patients, 25 feet who underwent the procedure by a single surgeon (MDS) at the Shriners Hospitals for Children in Portland. All preoperative and postoperative radiographs were measured and analyzed and all clinic notes were reviewed. RESULTS: Major improvements were seen in the configuration of the foot. Significant differences were found between preoperative and postoperative anteroposterior standing radiographs by measuring the talo-first metatarsal angle, the talo-calcaneal angle, the calcaneal-second metatarsal angle, and the calcaneal-fifth metatarsal angle (P<0.005). On the lateral view the talo-first metatarsal, the talo-calcaneal, the tibio-talar, the tibio-calcaneal, and the pitch angle did not show any change. An unexpected finding was that after the surgery, the lateral subluxation of talo-navicular joint was partially corrected. CONCLUSIONS: This retrospective study suggests that combined medial cuneiform opening-wedge osteotomy with transmetatarsal osteotomy through the base of second to fifth can effectively correct this deformity regardless of the underlying cause. In our cases, we achieved good clinical and radiographic results. We have used this procedure for patients 6 years and older who have moderate to severe forefoot adductus. LEVEL OF EVIDENCE: Level IV-therapeutic studies.

Nuevo enfoque terapéutico del metatarso varo congénito y residual de pie varo equino. Estudio de cinco años / New therapeutic approach of the congenital metatarsus varus and residual varus equine foot. Five-year study

Fundamento: el metatarso varo es una enfermedad frecuente en las deformidades del pie del neonato. Objetivo: valorar el nuevo enfoque terapéutico en el metatarso varo congénito y residual de pie varo equino en un estudio de cinco años. Metodología: se realizó un estudio descriptivo longitudinal en 81 niños con el diagnóstico de metatarso varo, los que fueron atendidos en el servicio de Ortopedia y Traumatología del Hospital Pediátrico Universitario Eduardo Agramonte Piña, en el período comprendido desde enero del 2002 hasta diciembre del 2007. A partir de la consulta directa con 30 expertos, los resultados se procesaron estadísticamente con la prueba de Alpha de Cronbach . Resultados: predominaron el metatarso varo congénito, los pies bilaterales, la edad de cinco a nueve años. El resultado final fue exitoso en todos de los pacientes al corregir el parámetro clínico estático y en la mayoría el dinámico. Conclusiones: el nuevo enfoque terapéutico une los criterios clínicos y radiológicos para un mejor diagnóstico del metatarso varo. La técnica es efectiva y sencilla al ser menos invasiva sobre partes blandas, al realizarse en un tiempo quirúrgico breve las complicaciones son mínimas y se usa menos material gastable lo cual produce beneficios económico al país. Los resultados obtenidos son conclusivos debido a que la serie es adecuada y el seguimiento realizado fue a largo plazo.

Background : the metatarsus varus is a frequent illness in the deformities of the foot of the neonate. Objective : to value the new therapeutic approach in the congenital metatarsus varus and residual varus equine foot in a five-year study . Methodology : a descriptive longitudinal study in 81 children with the metatarsus varus diagnosis was carried out, these children were cared in the Orthopedics and Traumatologic service of the Pediatric University Hospital "Eduardo Agramonte Piña", from January, 2002 to December, 2007. Starting from the direct consultation with 30 experts, the results were processed statistically with the test of Alpha of Cronbach. Results: the congenital metatarsus varus, bilateral feet and the age five to nine years prevailed. The final result was good in all of the patients when correcting the clinical static parameter and in most them the dynamic one. Conclusions : the new therapeutic approach unites the clinical and radiological criteria for a better diagnosis of the metatarsus varus. The technique is effective and simple as it is less invasive on soft parts, complications are minimal as it is carried out in a brief surgical time and less expendable material is used for which it brings about economic benefits to the country. The obtained results are conclusive because the series is suitable and the performed follow up was long term.