Module 8, General Medical Level

A 2 month old male infant presented for an evaluation of the left foot. The child is the product of a normal pregnancy and delivery and currently has no recognized medical problems except for the left foot which the mother reported was noted at birth to be able to fold back on it self. The mother was instructed to stretch the foot every time she changes the diaper. Her current complaint is that the foot has not gotten better and even seems to be worse. She is not able to get the foot flat and she says it has no arch. On physical examination the foot has hyperdorsiflexion forefoot abduction, no arch and can not be brought to neutral plantar flexion but can be dorsiflexed to almost having the toes touch the front of the tibia.

Question 8A

New born infants with hyper-dorsiflexion usually have a calcaneovalgus foot deformity which should be treated as was recommended with stretching exercises by the mother.

Question 8B

The fact that this deformity is not resolving, suggests this is not a simple intra-uterine positioning deformity and further investigation is indicated.

Question 8C

This foot has a club foot deformity and needs to be treated with a cast.

Question 8D

This kind of foot deformity is rarely an isolated deformity.

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Question 8E

The presence of a hard mass in the arch and total absence of the arch is a very pathologic finding and strongly suggests that this is not a calcaneovalgus foot deformity.

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