Module 43, General Orthopaedist Level

A six year old female followed for spastic quadriplegic cerebral palsy presented with increasing difficulty with ambulation secondary to bilateral hamstring tightness and progressive planovalgus deformity of the feet. Examination revealed a small thin six year-old female with severe bilateral planovalgus deformity which has become a progressive problem. While walking, the bilateral planovalgus deformity causes her to bear weight on her medial midfoot.

Question 43A

The planovalgus feet and increased crouching are unrelated problems in this girls ability to walk.

Question 43B

The primary treatment for these planovalgus feet should be articulated AFO's.

Question 43C

This girl has AFO's which have been modified several times but she still complains of pain over the prominent navicular. Therefore the orthotics should be switched to rigid molded arch supports.

Question 43D

On weight bearing x-rays the talocalcaneal angle is 44 degrees and talonavicular angle is 40 degrees. This indicates that surgery is definitely indicated.

Question 43E

In this girl, if surgery is to be considered the primary procedure should be a subtalar fusion.

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