Foot Problems, Common

Key Features

• 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

• Talipes calcaneovalgus 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

Clinical Findings & Diagnosis

• 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 (talipes equinovarus)

  • 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

• Talipes calcaneovalgus

  • 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

• 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)

  • 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 ...