6. pes calcaneovalgus anticevic 18.05.2011

8/22/2019 6. Pes Calcaneovalgus Anticevic 18.05.2011

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Pes calcaneovalgusPes metatarsus adductus

University of Zagreb, School ofMedicine

Department of Orthopeadics

Darko Antievi


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Pes calcaneovalgus


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Pes calcaneovalgus

Foot is dorsi-flexed, everted

The dorsum readily touches the

antero-lateral surface of the leg

Plantar flexion ceases at aroundthe mid-position

The foot as whole is anatomicallynormal


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Pes calcaneovalgus

The foot responds rapidly andfavourably to gentle manipulation

Streching towards plantar flexion

and varus

Resistance to primary correction

should be a signal to review thediagnosis and search for

neurological component


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Pes calcaneovalgus


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Pes calcaneovalgus

Rare posterior (benign)

angulation of the tibia, Vertical talus

Arthrogryposis multiplex

Neurological condition


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Pes calcaneovalgus

The mother should be instructed to

strech the foot into equinus andvarus,

Prognosis is good, In few patients a flat foot with some

fixed valgus of the heel may persist,

Developmental dyplasia of the hip

have to be ruled out.


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Pes metatarsus adductus

Medial deviation of the FF with various

degrees of supinaton and neutral or

mild valgus of the hindfoot

Confusing terminology:

metatarsus adductovarus;

metatarsus varus;

skewfoot.


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Pes metatarsus adductus

Common condition in infants

Rarely seen in older children

Common cause of intoeing

More obvious btw. 6-12 months or when

child starts to walk


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Pes metatarsus adductusDifferential Diagnosis

Club-foot (mildform)

Serpentine foot(rare structuraldeformity)

Rare forms ofhallux varus


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Metatarsus adductus - etiology

intrauterine positioning or molding


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Metatarsus adductus - etiology

Muscle imbalance (Kite, 1967.)

Tibialis anterior insertion into

plantar aspect of the medial

cuneiform,

Contracture of the capsular

ligaments Combination of above

JBJS(B) 1979.


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Metatarsus adductus evaluation:

Foorefoot deviated towards midline

Hindfoot is normal or in mild valgus

No vasting of the calf muscles Hallux varus


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Bleck classification: the heel bisector method

Evaluation


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Clinical

picture


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Metatarsus adductus treatment:

benign natural history; treatment rarely needed (1 in 10);

spont. resolution in 86% pts. to

age 4 y.

serial casting only in severe type;

Rushforth GF. JBJS(B)1978

Ponseti & Baker, JBJS(A), 1966.


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Metatarsus adductus treatment:

surgery in older patient withsymptoms;

soft tissue surgery; double osteotomy of midfoot

(open wedge medial cuneiform

+ closing wedge cuboid).


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Metatarsus adductus indications:

surgery in patient with

symptoms older than

2 years; Poor shoe fitting;

Severe forms(Bleck classification)


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14 years girl poor shoe-fitting + occasional pain

Metatarsus adductus


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Abductor hallucis tendon release


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Pre-operative

Post-operative


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Naviculo-metatarsal angle


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X-ray of medial soft tissue release by

capsulotomy in severe type of metatarsusadductus


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Skewfoot

Is rare deformity with componentsof malignment in forefoot, midfootand hindfoot.

Forefoot is on adduction,navicular is laterally subluxatedand heel is in valgus.

Etiology is unknown.


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different structural relationship

of foot bones

equinovarus

footmetatarsus

adductus

skewfoot

normal foot

vertical

talus


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metatarsus adductus: double

osteotomy of midfoot


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skewfootFour years after op,: clinical &

X-ray appearance of both foot

after double osteotomy of the

left foot.

R L

L


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skewfoot

Three months post-op. (right foot)

- double osteotomy of the midfoot

R

6. pes calcaneovalgus anticevic 18.05.2011

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