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Key Features

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  • Metatarsus adductus

    • Most common foot abnormality

    • Observed in newborns at a rate of 1–2 per 1000 live births

  • Clubfoot

    • Occurs in approximately 1 per 1000 live births

    • The three major categories of clubfoot are idiopathic, neurogenic, and those associated with syndromes such as arthrogryposis and Larsen syndrome

  • Flatfeet

    • Around 15% of flatfeet do not resolve spontaneously

    • There is usually a familial incidence of relaxed flatfeet in children who have no apparent arch

  • Talipescalcaneovalgus occurs in 0.4-1.0 per 1000 live births

  • Cavus foot

    • Consists of an unusually high longitudinal arch of the foot

    • May be hereditary or associated with neurologic conditions such as poliomyelitis, hereditary sensory motor neuropathies, and diastematomyelia (congenital splitting of the spinal cord)

  • Bunions

    • Most common forefoot deformity with a prevalence of 23–35%

    • Etiology is unknown

    • Around 60% of patients have a family history of this condition

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Clinical Findings & Diagnosis

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  • Metatarsus adductus

    • Characterized by inward deviation of the forefoot

    • When the deformity is more rigid, it is characterized by a vertical crease in the medial aspect of the arch

    • The etiology of rigid deformities is unknown

    • Angulation occurs at the base of the fifth metatarsal causing prominence of this bone

    • Most flexible deformities are secondary to intrauterine positioning and usually resolve spontaneously

    • Hip dysplasia may be present in 10–15% of children with metatarsus adductus; careful hip examination is necessary

  • Clubfoot (talipesequinovarus)

    • Requires three features for diagnosis: (1) plantar flexion of the foot at the ankle joint (equinus), (2) inversion deformity of the heel (varus), and (3) medial deviation of the forefoot (adductus)

    • Infants should be examined carefully for associated anomalies, especially of the spine

    • Idiopathic club feet may be hereditary

  • Flatfoot

    • Normal in infants

    • If the heel cord is of normal length, full dorsiflexion is possible when the heel is in the neutral position

    • As long as the heel cord is of normal length and a longitudinal arch is noted when the child is sitting in a non–weight-bearing position, a normal arch will generally develop

    • Younger children who are male, obese, and have excessive joint laxity are more likely to be flatfooted

    • In any child with a shortened heel cord or stiffness of the foot, other causes of flatfoot such as tarsal coalition (congenital fusion of the tarsal bones) should be ruled out by a complete orthopedic examination and radiographs

  • Talipescalcaneovalgus

    • Characterized by excessive dorsiflexion at the ankle and eversion of the foot

    • Can be associated with posteromedial bowing of the tibia and is due to intrauterine position and is often present at birth

  • Cavusfoot

    • Consists of an unusually high longitudinal arch of the foot

    • May be hereditary or associated with neurologic conditions such as poliomyelitis, hereditary sensory motor neuropathies, and diastematomyelia (congenital splitting of the spinal cord)

    • There is an associated contracture of the toe extensors, producing a claw toe deformity in which the metatarsal phalangeal joints are hyperextended and the interphalangeal joints acutely flexed

    • Cavus foot presents with diffuse ...

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