Module 10, General Medical Level

A 6 year old white male presents with a history of an undiagnosed skeletal dysplasia. Previous surgery includes bilateral femoral and tibial osteotomies for valgus deformities. His knee alignment is now normal. His main complaint is the development of painful callus over the arch of his foot and difficult in fitting shoes. These deformities of the feet have been getting worse by the description given by the mother. His foot deformity has never been treated with casts or splints. On examination he has a short thick foot with a kidney bean shaped curve to its lateral border. The arch is not high but has a heavy callus bilaterally.

Question 10A

This is a typical description of the residual effects of severe metatarsus adductus commonly seen in infants.

Question 10B

This history and current problem suggests that an xray of the foot should be obtained.

Question 10C

Because this boy's mother has been given a diagnosis of unclassified bone dysplasia, the further treatment of the feet should be held up until a full evaluation of the underlying possible bone dysplasia is worked up by an expert on skeletal dysplasia.

Question 10D

A careful family history is a very important part in the evaluation of this child.

Question 10E

An important aspect of the work up of bone dysplasia is to obtain an MRI scan of the spine because there is often spinal involvement.