Module 8, General Orthopaedist Level
A 2 month old male infant present 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
The correct treatment at this time is to apply corrective casting to bring
the foot into equinus.
Question 8B
A
definitive diagnosis of this child's foot could be made on a lateral x-ray
at this time.
Question 8C
You
tell the mother should expect that it would take about 3 to 6 months to
gain full correction of this deformity with casts.
Question 8D
The
peroneal muscles are the primary contracted structures on the lateral border
of the foot.
Question 8E
If
this child has any tone or muscle abnormalities, a careful evaluation including
chromosomal analysis should be performed.
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