when babies are born they come out looking like__________
Cowboys
metatarsus adductus is most common under ___ years, usually with _______ portion
2
tibial
true or false – metatarsus adductus usually occurs bilateral in 50% of the cases
true
what percent of patients that have metatarsus abductus also have acetabular dysplasia
10%
true or false – metatarsus adductus usually resolves spontaneously
true – faster with therapy/shoe modification
you can also put the shoes on the other feet
what percentage of cases of metatarsus abductus qualify for surgery
5%
what kind of surgery is this
surgery for metatarsus adductus
After failed conservative treatment
2 – 4 years tarsometatarsal capsulotomies
cut ligament joint capsule
4 year multiple metatarsal osteotomies
what is this condition
metatarsus adductus
what is this condition
calcaneovalgus foot deformity
is calcaneovalgus foot deformity very common
yes
what is calcaneovalgus foot deformity and what is its treatment
dorsi flexed, forefoot abduction, heel valgus
treatment is stretching and should be better within six months
what is this condition
flexible pes planus
what condition is one of the most aggravating conditions for parents and grandparents
flexible pes planus
true or false – if you have flat feet and it doesn't hurt you probably don't need to do anything
true – however at the patient has flat feet and they do hurt that is when you need to examine the patient very closely
true or false – a normal foot arch develops in later childhood
true
what is the treatment for flexible pes planus if symptoms are present
consider over-the-counter orthotic – ( hard to find for kids)
custom orthotics ( not recommended because of expense)
check the quality of shoes and the quality of arch support
when should have flexible pes panus surgery be done
pain necessitates it - not cosmetic
parents/patient will trade inversion/E version for release of pain and disability
A version of arthrodesis usually done
what does arthrodesis mean
fusion
what are the two types of rigid flat foot
vertical talus (convex pes valgus)
tarsal coalition (peroneal spastic flatfoot)
what is vertical talus
abnormal position of talus
presents a rocker bottom foot
present at birth, seen with conditions like arthrogryposis or spina bifida
surgery best to realign talus and pin other joints in place (6-2 years)
what is Tarsal coalition
abnormal fusion from calcaneous to navicular or calcaneous to talus
usually not a problem until teens or 20s after recurrent ankle sprains
surgery to disconnect the coalition
what is this condition
vertical talus
what is this condition
clubfoot
what is this condition
tarsal coalitions
what is the cause of clubfoot (talipes equinovarus)
cause is unknown – abnormalities of nerves and muscles and/or the blood supply to the foot
how many people out of the thousand will have clubfoot
one
what is clubfoot
bones are abnormally shaped and tendons, muscles, and ligaments are tight
what does clubfoot cause
toeing in
true or false – 50% of patients that have clubfoot will have bilateral deformity
what are the four types of club feet
positional
teratologic
syndromic
congenital
explain positional club feet
a positional clubfoot is a normal foot that was held in an abnormal position in utero. The bone alignment is normal in the foot is usually corrected by stretching or a short course of casting
explain teratologic clubfoot
is associated with neurological disorders such as spina bifida
explain syndromic clubfoot
is associated with an overall genetic syndrome such as arthrogryposis. Both teratologic and syndromic clubfeet almost always requires surgery as definitive treatment, although casting does help stretch the soft tissue in preparation for surgery
explain congenital clubfeet
a congenital clubfoot is a foot with abnormal bone deformity present at birth but not associated with any neuromuscular cause or syndrome
what is the treatment for clubfoot
the initial nonoperative treatment is manipulation and casting. ( works for some- 15 – 80%)
The surgical treatment
necessary for rigid deformities
releases ligaments to move bones
osteotomy to move bones
arthrodesis to fuse bones
what is this condition
Severs disease
explain the characteristics of Severs disease
presidents with Heel pain
apophysitis
girls and boys, usually at about eight – 14 years of age
what is the treatment or intervention for severs disease
relative rest
heel cup
over-the-counter inserts orthotics
shoe changes may be necessary to control this condition
stretching of the lower lands ( all muscle groups – easy on gastroc and soleus) - unload insertion of gastroc
what sports is Severs disease common in
basketball, soccer, volleyball
what does this graph represent
the way the bones in the lower extremity develop
be able to draw this graph and explain it
what is another name for genu varum
bowlegs
true or false – genu varum will spontaneously resolve in 95% with walking
true
true or false – genu varum will convert to to knock knee, then resolve at age 4 –7
true
what is this condition
Blount's disease (tibia varum)
what is blount's disease
differential growth of the upper medial tibial epiphysis – maybe from abnormal pressure
more common in obese patients
early walkers
true or false – Blount's disease will get worse, not better
true
true or false – Blount's diseaseis more common in African Americans
true
it is also more common in females
what is this condition
genu valgum or knock knee
when does genu valgum present and when does it resolve
3–5
5-8
true or false – causes of genu valgum other than physiologic or posttraumatic are unusual
true
what is this condition
tibial torsion
what are the characteristics of tibial torsion
cause of toeing in
tibia is normally rotated externally in relation to the femur by 20°
diagnosis – has internal tibial rotation this tibia internal rotation is more than 10° – 20°
no evidence that in toeing causes adult trouble
how should tibial torsion be treated
treat with reassurance
results with growth and development
shoes, stretching not helpful
what do these diagrams help assess
internal tibial torsion
what is this condition
Osgood schlatter disease
what is this condition
a severe case of Osgood schlatter disease
explain the basic characteristics of Osgood schlatter disease
present with knee pain
pain with running, jumping
apophysitis
girls and boys, usually at about 8 – 14 years of age
exam: tender over tibial tumor tuberosity, tight rectus femoris
what is intervention for Osgood schlatter disease
relative rest/activity modification
stretching of the lower limbs ( all muscle groups – ( easy on rectus femoris – decrease load on TT)
can be intermittent until late teens
bad cases – needs screws
what is a red flag for toddlers fracture
the infant doesn't want to walk
antalgic gait
what is the age range of toddlers fracture
1 –5
what is a common cause of toddlers fracture
jumping off the couch
what is this condition
toddlers fracture
what three things should be done for toddler fracture during an examination
palpate tibia
ambulation observation
x-ray
what is intervention for toddler fracture
casting 3 – 4 weeks
if the patient has medial knee pain you should then always check another joint. What is that joint
Hip
what does DDH stand for
developmental dysplasia of the hip
what are some of the characteristics of developmental hip dysplasia
usually in the firstborn child
occurs more often in girls
breach presentation at birth
developmental hip dysplasia usually occurs in what leg
left leg – for reasons unknown
what is a positive ortolani or barlow test
popping in and out of the femoral head into the acetabulum
what is this condition
developmental hip dysplasia
what is a sign called and what is it used to assess
telescoping sign
developmental hip dysplasia
but kind of harness is this
pavlik harness
the intent is usually in this harness for about six months to one year
six months is the optimal window to treat DDH
what is the most common cause of in toeing in children > 2 years old
internal femoral torsion
true or false - normal anteversion moves from 30° to 15° as mature
true
internal femoral torsion is more common in males or females? What is the ratio
females
2:1
true or false – pressure is usually spontaneous around school age for internal femoral torsion
true
what is this condition
idiopathic femoral anteversion
what is this condition? can we fix it?
idiopathic femoral anteversion
no because this is bone malformation
what special test can be used to identify idiopathic femoral anteversion
Craigs test
what is legg-Calves-Perthes disease?
avascular necrosis of the femoral head
interruption of blood supply to the femoral headresults in collapse, fragmentation of the hip joint
what is the age range for legg-Calves-Perthes disease
4 – 10 years
is legg-Calves-Perthes disease more common in males or females? What is the ratio
males
4:1
bilateral in 25%
how does legg-Calves-Perthes disease present
presents with hip pain or a limp. 30% of cases the pain may initially be referred to the thigh or knee
decreased hip internal rotation
true or false – 25% of untreated cases of legg-Calves-Perthes disease will result in serious the formation of the hip joint
true
can legg-Calves-Perthes disease result in early-onset of osteoarthritis in adulthood
yes
what is the progression oflegg calves perthes disease
necrosis
fragmentation
healing
remodeling
the percentage of legg-calves-perthes disease have a negative outcome
25%
what percentage of legg-calves-perthes disease have a positive outcome
75%
true or false – patients with legg-calves-perthes disease are more likely to have osteoarthritis in the future
true
what is a good prognosis for legg-calves-perthes disease
age less than six years at the onset of symptoms
less than 50% of had involvement
no stiffness or shortening on exam
what is a bad prognosis for legg-calves-perthes disease
age more than seven years at the onset of symptoms
more than 50% of had involvement
significant stiffness or shortening on examination
what is intervention for legg-calves-perthes disease
containment of the necrosis or fragmentation. Femoral head malleable contain the femoral head deep within acetabulum until healing occurs
Correction osteotomy for cases that have entered the healing or remodeling stages. unlikely to remodel by containment
what is this kind of brace used for
legg-calves-perthes disease
Puts the for moral head into the acetabulum without allowing much movement
patient is allowed weight bear
brace can be on for up to two years
they are messy and require a lot of maintenance
if a patient has legg-calves-perthes disease or any other hip pathology where will the pain be located
in the groin
what is this condition
slipped capital femoral epiphysis
what is age range for slipped capital femoral epiphysis
most common cause of hip pain and adolescent age group 10 – 15 years old
what is slipped capital femoral epiphysis
progressive slip of the femoral head
obese children
positive family history
is slipped capital femoral epiphysis more common in males or females
males
2:1
what happens if slipped capital femoral epiphysis is left untreated
untreated it may result in severe limb shortening, fixed external rotation and stiffness of the hip
what is the treatment for slipped capital femoral epiphysis
insert a single cannulated screw percutaneously under x-ray control
post-operative recovery is generally rapid, but a of protected weight-bearing with crutches for six weeks is recommended
how long does it take for children to heal from a fracture
4 to 6 weeks
how long does it take for an adult the heal from a fracture
6 to 8 weeks
don't forget to go over the case studies in the PowerPoint
