Module 23, Pediatric Orthopaedist Level

This a 13 year old white female complains of left foot pain. The pain has been present for approximately 2 years. There is no specific history of a traumatic event. The pain is primarily at the lateral aspect of the foot and is worse at the end of the day. The pain is somewhat relieved by rest. The left foot is without swelling. It is tender in the anterolateral aspect of the foot. Ankle motion is normal. Subtalar motion is significantly limited.

Question 23A

This condition is usually thought to be autosomal dominant inheritance with variable penetrance.

Question 23B

The etiology of the above problem appears to be a defect in segmentation and differentiation of the primitive mesenchyme

Question 23C

A conservative treatment of casting and orthotic use has no scientific basis of support for this condition.

Question 23D

The etiology of the spastic flat foot is a neurologic response to inflammation in the subtalar joint causing spasticity of the peroneal muscles.

Question 23E

Because additional coalitions occur in 15 percent of the feet with a talonavicular coalition, a CT scan of the talocalcaneal joint is required prior to excision of the talonavicular bar.