HSS spring - club foot and osgood schlatter's

  1. 4 elements of congenital clubfoot
    • hindfoot equinus
    • forefoot add and inversion
    • heel in varus
    • medial sublux of head of talus
  2. etiology of congenital clubfoot is unknown, but 3 ideas...
    • mechanical factors (crowding in utero)
    • germ plasma defect (problem w formation of muscles and tendons at 8-12 weeks)
    • neuromuscular imbalance
  3. clubfoot - in what fraction of births? gender divide? how often bilat? increased risk if a sibling has it?
    • 1/1000
    • 2:1 m:f
    • 50% of cases are bilat
    • 2-5% increased risk if a sibling has it
  4. contractures in clubfoot
    • plantar muscles
    • plantar fascia
    • post capsule of tibiotalar and subtalar jts
  5. 4 tight muscles in clubfoot
    • triceps suraeĀ 
    • posterior tib
    • flexor hallucis longsus
    • flexor digitorum longus
  6. the look of a clubfooted foot
    • foot and calf are smaller
    • deep creases on medial sole an sup heel

    diagnosable prenatal as early as 16 weeks
  7. order of events in stretching out clubfoot
    • start w adduction and inversion
    • then, when this is achieved, address the plantar flexors
  8. casting for clubfoot
    • begin asap after birth
    • change weekly
    • cont -10 weeks or when 1) correction is achieved, 2)rockerbottom posture is noticed, 3) continued correction ceases
  9. 4 risks of casting for clubfoot
    • rockerbottom
    • increased cavus deformity
    • post surface of talus flattens creating stiffness and decreased mobility
    • skin irritation & decubiti
  10. rockerbottom foot
    forefoot isn't corrected before the hindfoot, so forefoot DFs on the hindfoot
  11. adequate ranges of PF and DF
    • PF > 20 degrees
    • DF > 10
  12. basic tx strategies for three age groups for club foot
    • <6 - soft tissue procedures
    • 6-12 - combo of soft tissue release and limited bony procedures
    • > 12 - boney
  13. soft tissue release for clubfoot
    release all the ant, post, med, lat, and plantar structures

    • can also do heel cord lengthening
    • post-med release
  14. post-op management after soft tissue clubfoot release
    • cast 6-12 weeks, changing cast every 1-2 weeks, trying to increase DF each time
    • after cast removal, supplemental bivalve casts, corrective shoes, and/or orthoses are used
  15. 5 things to eval post-op clubfoot surgery
    • (there's more for this list in the notes)
    • ankle ROM
    • ankle strength
    • stair negotiation
    • single leg stance
    • sit <--> stand
  16. what is Osgood Shlatter's disease?
    overuse injury resulting in knee pain

    caused by: partial avulsion of tibial tubercle... traumatic patella tendonitis --> heterotropic bone formation in tendon
  17. ossification of tibial tubercal begins and finishes when?
    • begins - 7-9 y/o
    • completed - 15 y/o
  18. why does OSD hit adolescents?
    the unossified cartilage where the patella tendon inserts is susceptible to repeated trauma w activity
  19. who gets OSD, what age, when, how often bilat?
    • mostly males 11-14 y/o
    • (rarely in females, but then 10-11)
    • happens during growth spurt bc bone grows faster than muscle
    • bilat 50% of time
  20. where is the pain in OSD?
    localized to tibial tubercle
  21. what aggravates OSD pain, what reproduces it?
    • aggravated by eccentric quad activities
    • reproduced by resisted knee ext
  22. radiograph in OSD?
    • need it to r/o more serious bone pathology
    • in OSD it'll show areas of irregular bone deposition and resorption
  23. 3 diffy diags for OSD
    • quadriceps tendon avulsion
    • pes anserinus bursitis
    • patellar tendonitis
  24. prognosis for OSD
    excellent - usually resolves spontaneously within one year, though discomfort may last 2-3 yrs til tibial growth plate closes

    might have permanent painless bump below knee
  25. PT for OSD
    • instruct pt to modify activity - avoid kneeling, jumping, running
    • recommend swimming or cycling
    • hamstring stretches
    • rehab of quads (stretching, quad sets, SLR, short arc squats)
  26. excercises for OSD
    • hamstring stretches
    • quad rehab: stretching, quad sets, SLR, short arc squats
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HSS spring - club foot and osgood schlatter's
HSS spring - club foot and osgood schlatter's