ABSTRACT
This study describes the management of foot deformity in children. Severe congenital clubfeet treated using posteromedial release without talocalcaneal joint release were flexible and functional. Talectomy may be necessary for congenital clubfeet with arthrogryposis multiplex congenita. The diagnosis and severity of vertical talus were defined based on stress radiographs. For the deformity with spina bifida, a combination of talocalcaneal joint fusion and precise correction by soft tissue release and tendon transfer was performed. This combined surgery is effective, particularly in patients with equino-varus feet.
Subject(s)
Foot Deformities, Congenital/diagnostic imaging , Foot Deformities, Congenital/surgery , Orthopedic Procedures/methods , Arthrogryposis/diagnostic imaging , Arthrogryposis/surgery , Child , Child, Preschool , Clubfoot/diagnostic imaging , Clubfoot/surgery , Flatfoot/congenital , Flatfoot/diagnostic imaging , Flatfoot/surgery , Follow-Up Studies , Humans , Radiography/methods , Recovery of Function , Risk Assessment , Treatment OutcomeABSTRACT
Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients. The tight, press-fit nature of the tricortical iliac crest allograft provides stability and can negate the need for internal fixation. We retrospectively reviewed 9 pediatric subtalar joint distraction arthrodesis procedures performed on 8 patients during a 6-year period. All patients began weightbearing at 6 weeks after surgery. All patients had osseous union, and no complications developed that required a second surgery. The clinical outcomes, assessed at a mean of 25.5 (range, 6.3 to 75.8) months postoperatively, were satisfactory. The mean American Orthopaedic Foot and Ankle Society score was 90.1 (range, 79 to 94), on a 94-point scale. The wedged distraction arthrodesis technique has not been previously described for correction of pediatric patients with lateral tarsal wedging, but it is an effective option and yields successful outcomes.
Subject(s)
Calcaneus/surgery , Flatfoot/surgery , Foot Deformities, Congenital/surgery , Subtalar Joint/surgery , Tarsal Bones/surgery , Adolescent , Arthrodesis , Bone Transplantation , Calcaneus/abnormalities , Child , Female , Flatfoot/congenital , Foot Deformities, Congenital/diagnosis , Humans , Male , Subtalar Joint/abnormalities , Tarsal Bones/abnormalitiesABSTRACT
To optimize the diagnosis and treatment for the inborn flat-valgus deformity of the foot (IFVDF), the results of treatment of 78 children, ageing from 1 mo to 12 yrs old, were analyzed. Algorithms of diagnosis and treatment were elaborated. Operative treatment on soft tissues for IFVDF was indicated in the cases of inefficacy or insufficient efficacy of conservative therapy in the age after 1 year old, when a child starts to walk by himself. The proposed method of operative treatment permits to achieve good results and it is less traumatic in comparison with the existing methods. Better results are noted while application of the method in children, ageing from 1 to 4 yrs old.
Subject(s)
Flatfoot/surgery , Flatfoot/therapy , Manipulation, Orthopedic/methods , Child , Child, Preschool , Female , Flatfoot/congenital , Foot Orthoses , Humans , Infant , Male , OsteotomyABSTRACT
Trichorhinophalangeal type I (TRPS I) is a rare autosomal dominant disorder characterized by variable clinical expression of sparse and slow-growing hair, pear-shaped nose, elongated philtrum, and bone deformities, including cone-shaped epiphyses of the phalanges and short stature. We describe three members of a family who consulted us because of slow-growing scalp hair with craniofacial and radiological features typical of TRPS I.
Subject(s)
Craniofacial Abnormalities/genetics , DNA-Binding Proteins/genetics , Finger Phalanges/abnormalities , Hair/abnormalities , Mutation, Missense , Transcription Factors/genetics , Body Height/genetics , Child , Female , Finger Phalanges/diagnostic imaging , Flatfoot/congenital , Flatfoot/genetics , Humans , Male , Palate/abnormalities , Radiography , Repressor Proteins , SyndromeABSTRACT
CASE: Congenital vertical talus (CVT) is a rare rigid flatfoot disorder with a rocker-bottom flatfoot appearance. It is characterized by hindfoot valgus and equinus, with associated midfoot dorsiflexion and forefoot abduction. We describe a patient who was born with dysmorphic features and subsequently was diagnosed with Beals contractural arachnodactyly. After the diagnosis of bilateral CVT was made, it was treated with a single-stage open reduction. There was a unilateral recurrence, which was treated with revision surgery. The patient had an excellent functional outcome. CONCLUSION: CVT often requires surgical management and may recur. To our knowledge, this is the first reported case of CVT associated with Beals contractural arachnodactyly.
Subject(s)
Arachnodactyly , Contracture , Flatfoot/surgery , Child, Preschool , Flatfoot/congenital , Flatfoot/diagnostic imaging , Humans , Infant , Orthopedic ProceduresABSTRACT
Eleven cytogenetically documented patients with the fragile X syndrome were evaluated for hyperextensibility of the finger joints and the presence of other manifestations of connective tissue dysfunction. All of the patients had hyperextensibility of several finger joints and many had features such as flat feet, highly arched palate and the ability to voluntarily dislocate finger joints. These traits, particularly hyperextensibility of the joints, are a useful aid in the clinical diagnosis of the fragile X syndrome.
Subject(s)
Connective Tissue/physiopathology , Finger Joint/physiopathology , Fragile X Syndrome/physiopathology , Sex Chromosome Aberrations/physiopathology , Abnormalities, Multiple , Child, Preschool , Flatfoot/congenital , Fragile X Syndrome/diagnosis , Humans , Male , Movement , Palate/abnormalitiesABSTRACT
Dissections of the feet of a three-month-old infant with paralytic congenital vertical talus secondary to lumbar myelomeningocele were compared with a dissection of a normal foot. The major differences appeared to be absence of the plantar intrinsic muscles and dorsal dislocation of the talonavicular joint. It is postulated that the pathological process begins as a failure of the intrinsic muscles to oppose the unbalanced, active dorsiflexion forces of the anterior crural muscles. This imbalance then allows disruption of the talonavicular joint, mechanically the least stable joint in the mid-part of the foot. All dorsiflexion forces acting on the ankle then become ineffective and plantar flexion forces serve only to pull the calcaneus and talus into equinus, causing a "vertical" talus. Treatment must be directed at reducing the talonavicular dislocation, correcting the equinus deformity of the hind part of the foot, and substituting for the undeveloped plantar intrinsic muscles.
Subject(s)
Flatfoot/congenital , Paralysis/congenital , Flatfoot/pathology , Foot/pathology , Humans , Infant , Male , Meningomyelocele/complications , Paralysis/etiology , Talus/pathologyABSTRACT
Twelve patients with sixteen feet showing true congenital vertical talus were treated at Children's Hospital of Pittsburgh by excision of the navicular as an adjunct to open reduction. When these children were evaluated two to fifteen years after naviculectomy, all were asymptomatic and fully active. Except for one Achilles-tendon lengthening (three months after naviculectomy), none had required further surgical procedures. Fifteen feet were examined in detail. Assessed on an anatomical basis, three of the feet were excellent; seven, good; four, fair; and one, poor. The best results were obtained in the patients who were eighteen months old or younger at the time of operation.
Subject(s)
Flatfoot/surgery , Achilles Tendon/surgery , Age Factors , Child , Child, Preschool , Female , Flatfoot/congenital , Flatfoot/diagnostic imaging , Follow-Up Studies , Humans , Infant , Male , Methods , Radiography , Talus/surgeryABSTRACT
Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet.
Subject(s)
Flatfoot/congenital , Talus/abnormalities , Child, Preschool , Female , Flatfoot/diagnostic imaging , Flatfoot/therapy , Follow-Up Studies , Humans , Infant , Male , Manipulation, Orthopedic , Methods , Radiography , Talus/diagnostic imaging , Tendons/surgeryABSTRACT
Seventeen feet of 12 patients with congenital vertical talus, which were treated with a single-stage surgical correction of complete subtalar release and peritalar reduction by using the Cincinnati incision, were reviewed. Five of the feet were associated with neuromuscular disorders, four with neural tube defects, and eight were idiopathic. All patients were operated on by the same surgeon and all were available for clinical and radiographic follow-up averaging 42.9 months (range 19-81) from the time of surgery. There were no wound complications or avascular necrosis of the talus. None required subsequent reoperation. At final follow-up, results were based on clinical and radiographic outcomes and included five excellent, eight good, two fair, and two poor. All families were satisfied with the results and appearance of the feet. Radiographically, there was a significant improvement in the anteroposterior and lateral talocalcaneal and talo-first metatarsal angles, and at follow-up, the group averages for each of these angles were within the normal ranges. In the treatment of congenital vertical talus, good clinical and radiographic outcomes can be obtained, with a low incidence of complications, using this single-stage surgical correction procedure.
Subject(s)
Flatfoot/congenital , Flatfoot/surgery , Talus/surgery , Child, Preschool , Female , Flatfoot/physiopathology , Humans , Infant , Male , Orthopedic Procedures/methods , Postoperative Period , Range of Motion, Articular , Treatment OutcomeABSTRACT
The congenital convex pes valgus deformity has been presented in reference to its etiology, pathologic anatomy, diagnosis, and treatment. It is imperative that this deformity be diagnosed immediately and treatment instituted rapidly to achieve a functional plantigrade and asymptomatic foot.
Subject(s)
Flatfoot/congenital , Clubfoot/diagnosis , Diagnosis, Differential , Flatfoot/diagnosis , Flatfoot/therapy , Foot/diagnostic imaging , Foot/surgery , Foot Deformities, Congenital , Humans , Infant , Infant, Newborn , Manipulation, Orthopedic/methods , Preoperative Care , RadiographyABSTRACT
Contracted valgus flat foot in the adolescent is frequently caused by tarsal synostosis or synchondrosis which are often not revealed in common radiographic views, and which may instead by clearly shown by CT scan. These synostoses are prevalently symptomatic during adolescence, when by ossifying they block the subtalar joint in valgus; they are less symptomatic between 20 and 40 years of age. Pain returns during the fifth decade due to the occurrence of secondary arthrosis of the nearby joints.
Subject(s)
Flatfoot/etiology , Synostosis/complications , Tarsal Bones , Adolescent , Adult , Age Factors , Female , Flatfoot/congenital , Follow-Up Studies , Humans , Male , Middle Aged , Tarsal Bones/abnormalitiesABSTRACT
Las coaliciones tarsales (unión fibrosa, cartilaginosa u ósea congénita entre dos huesos) a menudo son asociadas a una deformidad de pie plano en niños. Normalmente se presenta con esguinces de tobillo recurrentes o con inicio insidioso de un pie plano rígido doloroso y con limitación al movimiento de las articulaciones mediotarsianas y subastragalina. El diagnóstico clínico se confirma con radiografía, tomografía axial computerizada (TAC) y resonancia magnética nuclear (RMN). El signo de la nariz del oso hormiguero es causado por un alargamiento tubular del proceso anterior del calcáneo que se acerca o se superpone con el escafoides tarsiano y se asemeja a la nariz de un oso hormiguero en una radiografía lateral del pie o tobillo. El tratamiento de esta unión es primeramente sintomático, pero si el dolor persiste debe ser quirúrgico. Se presenta el caso de un niño de 10 años con coalición calcáneo-navicular bilateral asociada a pie plano valgo rígido (AU)
Tarsal coalition (a congenital fibrous, cartilaginous or bony connection between two bones) often leads to a flatfoot deformity in children. Usually it presents with recurrent ankle sprains or insidious onset of a painful rigid flatfoot and movement limitation of midtarsal and subtalar joints. Clinical diagnosis is confirmed by X-rays, computed axial tomography and nuclear magnetic resonance. The anteater nose sign is caused by a tubular elongation of the anterior process of the calcaneus that approaches or overlaps the tarsal scaphoid (navicular) and resembles the nose of an anteater on a lateral foot or ankle radiograph. The treatment of this union is primarily symptomatic but if the pain persists must be surgical. For a child of 10 years with bilateral calcaneus - navicular coalition associated with valgus rigid flatfoot arises (AU)
Subject(s)
Humans , Male , Child , Tarsal Coalition/complications , Flatfoot/congenital , Foot Orthoses , Sprains and Strains/etiology , Flatfoot/diagnostic imaging , Tarsal Coalition/diagnostic imaging , Radiography , Tomography, X-Ray Computed , Magnetic Resonance Spectroscopy , Conservative TreatmentABSTRACT
Rigid pediatric pes planovalgus refers to a condition of the foot in which the medial longitudinal arch height is abnormally decreased along with a significant loss of midfoot and hindfoot motion in the pediatric patient. Known causes for this condition are well documented and consist of congenital vertical talus, tarsal coalitions, and peroneal spastic flatfoot without coalition. This article outlines conservative and surgical treatment of rigid pediatric pes planovalgus.