Module 8, Pediatric 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. After casting the
foot for 10 weeks and x-ray was obtained which showed a talus to calcaneus
angle of 90 degrees on the lateral projection.
Question 8A
You tell the mother further casting is not likely to make much more improvement.
Question 8B
The
talar head and neck is usually very hypoplastic in this condition.
Question 8C
If
a surgical procedure is to be done, you would plan to lengthen all lateral
tendons on the foot and all ankle and toe extensor tendons.
Question 8D
The
surgical treatment should be planned for about 6 months of age, to allow
for maximum correction of the deformity before the secondary deformities
become severe.
Question 8E
Transfer
of the peroneus brevis to the neck of the talus is one method of trying
to maintain correction so the deformity does not recur.
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