Question | Answer |
Intoeing gait is caused from | metatarsus adductus (foot deformity)
internal tibila torsion ( rotational deformity)
excessive femoral anteversion ( rot deformity) |
roational profile for exam of intoeing gait | foot progression angle
evaluation of foot
prone hip rot
thigh foot rot (angle) |
morphologci features of MTA | adducted forefoot
concave med foot border
convex lat foot border |
MTA coption orrectable tx | stretching
reverse last shoes/straight last shoes
education |
MTA not correctable passively tx option | stetching
casting
reverse last shoes
surgical release |
MTA Surgical options | release adductor hallucis
mdial release
tarsometrsal capsulotomies multiple metatsal osteomies
lateral closing cuboid osteomis
opeing cuneform osteotomy |
Internal Tibial Tosion tx | NONE
rotational tibial osteotomy if
>10yrs old
medial thigh foot angle >10 degrees |
Excessive femoral anteversion | medial foot progression angle
medial hip rot > 70 degrees
most resolve by ten yrs of age |
tx for excessive femoral anteversion | none
rotational femoral osteotomy
.>10 yrs
80 degrees of prone medial hip rotation |
genu varum | physilogic bow legs
Blount's Disease |
Genu Valgum | knock knees |
nomal knee alignment at birth | 10-15 degrees varus |
normal knee alginment at 18 months | neutral |
30-36 months | genu valgum (outgrow in another 18 months part of normal growth |
Physiologic bowlegs (varum) | bilateral genu varum in child greater than 2
associated ITT
natural hx (spontaneous resolution) |
tx for physiolocal bow leg | none |
Tibial vara (BLOUNTs disease | proressive varus and ITT defomity of the proximal tibia |
etiology of Blount's disease | pathologic compression on the proximal medial tibial results in abnormal growth and development of proximal medial epiphis and pramture physeal closure |
who get blount's disease | fmale>males
overwight children
early walkers
african americans |
Knocked knees | genu valgum |
types of knock knees | physiologic
metabolic
skeltal dyplasia
post traumatic (Cozens
adolescence |
physicologic gen valgum | normal development 3-5 ys old child |
metabolic knocked knees | x-linked hypophosphatemia
renal osteodystophy |
genu valgu post traumatic (cozen) | s/p proximal tibial metphsis
overgorwoth with valgus deformity
increasing leg length
excellent remoldeling potential |
genu valgum adolescence | 10-11 yr old females 12-13 males
knee pain (medial)
large stature |
genu valgum tx | hemiephysiodesis
guided growth
stapling and 8-plating |
common foot deformities | calcaneovalgus
talipes equinovarus
pes planus
toe walking |
calcaneovalgus | present at birth
characterized by forefoot valgus and heel df allowing the dorsal suface to touch the anterior tibia |
etiology fo calcaniovalgus | inuterine molding |
tx for calcaneovalgus | observation
passive stretching
seral casting (rarely)
rule out tibial bowing |
talipes equinovarus | clubfoot: present at birth
forefoot adduction and supinated
heel pf |
etilogy for clubfoot | multifactoral
interuterine |
morphologic features | dimples oever talus
forefoot adduction
heel vaur
ankle equinus
shorter extremitiy smaller calf
short smaller foot |
clinical feature of club foot | cave principle
cavus
adductus
varus
equinus |
tx for club foot | treatable but no correctable
nonsurgical-->ponseti method (manipulation serial casting 3 months holding splints ) |
treatment results of clubfoot | abnomal foot
decreased size
calf atrophy
decreased motion
pes planus
MTA flat top of talus
dorsal cubluxation of forefoot |
treatment for pes plantus | none |
toe walking causes | idiopathic
cp myelodysplaia
muscular dystrophy |
toe walking | bilateral always
contracture develops
limits df |
idopathic toe walking clincal feature | cariable toe walking
altered choe wear
decreased df
normal neuro exam |
ideopathic toe walking rx | non operative ( stretching casting bracing and botox reoccurence common)
operative achilles tendon lengthening decreased strength reoccurance rare |
common hip conditons | transient synovitis and septic arthritis
developmetnal dysplasia
legg clave perthes
slipped capital femoral epiphysis |
transient synovitis and septic arthritis | pain
decreased ROM
refusal to bear weight |
transient synovitis | age 3-8
no/low fever
no systemic illness
inflammatory |
septic arthritis | ant greater then 2
fever
system ilness
infectious |
tx for transent synovitis | NSAID |
septic arthrits tx | I & D (incision and drainage)
sensitive antibiotic |
Developmental hip dysplasia | wasterbasket term encompassing all forms of hip instability including subluxation and dilocation |
developemental hip dysplasia incidence | incidence; 1-6 in 100 births
40-60 in left hip 20 bilateral famales> males |
developmentall hip dysplasia risk factors | first born female
positive familiy hx
breech presentatino
musculoskeletal abnomality |
etilogy of developmetn hip dysplasia | multifactorial (genetic disorder, hormonal factors and mechanical factors |
dx fo hip dysplasia | physical is more important thanradological exam
dynamic us |
DHD physical exam | ortolani
barlow
galeazzi |
ortonlani | reduces a dislocated hip |
barlow | dilocated hip |
galeazzi | leg length
shot leg is dislocated |
tx for hip dysplasia birth to 6 months | birth to 6 months pavik harness |
DHD tx 6-18 months | limited abduction
galeazzi test
telescoping
true shortenign
gait abnomalities |
complication with DHD | avascualr necrosis with Leg length discrepancy
coxa brevis
coxa valga
DJD |
legg clve perthes disease | condition of the immature hip caused by necrosis of al or part of the femoral head which subsequently deforms as necrotic bone is replaced by living bone |
stage of leff calve perthes | necrosis 5-7 months
fragmetnation 7-months
reossification 20-38 months
remolding ( until maturity |
clinical feature of legg perthes | painful limp groin pain anteriomedial thigh and knee
waddling gait
atrophic extremtiy
decreased ROM ( mid flexion contracture)
limited internal rotation and abduction |
tx for Legg calve perthes | mainatin ROM
head contaitnment (abd orthosis or maybe femoral pelvic osteotomy |
exercises for legg calve perthes | butterfly
knee to chest
standing straddle
hip extension prone |
prognosis for legg calve perthes | femoral head deformity
jt incongruity
impingement
86 percent have symptom of DJD before the age of 65 |
slipped capital femoral epiphysis (SCFE) | posterior and medial displacement of the |