Other foot and ankle conditions

Other foot and ankle conditions

Most postural deformities such as metatarsus adductus and calcaneovalgus feet improve spontaneously . Congenital vertical talus (CVT) is rare and fre - quently associated with neuromuscular conditions such as ‘rocker-bottom’ foot with dorsal dislocation of the navicular on the talus ( Figure 44.31 ). A ‘reverse’ Ponseti method with a limited surgical approach to reduce and Kirschner (K)-wire the talonavicular joint and a percutaneous Achilles tenotomy may be preferable to more extensive surgical releases. In tarsal coalition there is failure of segmentation of adjacent tarsal bones. School-aged children present with hindfoot pain and recurrent ankle sprains. The most common coalitions are talocalcaneal and calcaneonavicular ( Figure 44.4 ). Radiographs, computed tomography (CT) or MRI are used to confirm the diagnosis. Treatment is initially conservative, but if the coalition requires surgical excision this should be performed before degenerative changes develop. Other causes of foot pain in children include the osteo chondroses, in which the radiographic changes are similar to A VN. These ‘heal’ but the change in shape of the a ff ected bone may lead to secondary joint sti ff ness and loss of function. (Sim ilar ‘diseases’ a ff ect the lunate [Kienböck’s] and the capitellum of the humerus [Panner’s].) /uni25CF Freiberg’s osteochondrosis presents with forefoot pain and avascular change in the second metatarsal head. Symptomatic bony spurs and osteochondral fragments may need excision but often it is asymptomatic and seen as an incidental finding on a radiograph. /uni25CF Köhler’s disease presents with dorsal forefoot pain and swelling in young children. The navicular becomes avascu lar with alteration in the ossification process. /uni25CF Sever’s disease (enthesopathy of the calcaneal apoph ysis) presents with heel pain related to activity . Tightness in the calf muscle complex may be a contributing factor. The ‘features’ on a radiograph are, in fact, part of normal growth and de velopment. Flexed, medially curved ‘curly toes’ are common and rarely need treatment. Strapping is ine ff ective. Flexor tenotomy is used when there ar e symptoms or cosmetic concerns. Summary box 44.14 Other foot and ankle conditions /uni25CF /uni25CF /uni25CF /uni25CF

CVT – presents as ‘rocker-bottom’ foot Tarsal coalition – presents as a stiff, painful /f_l at foot Osteochondroses – almost always self-limiting Curly toes are common – most do not need treatment

Other foot and ankle conditions

Most postural deformities such as metatarsus adductus and calcaneovalgus feet improve spontaneously . Congenital vertical talus (CVT) is rare and fre - quently associated with neuromuscular conditions such as ‘rocker-bottom’ foot with dorsal dislocation of the navicular on the talus ( Figure 44.31 ). A ‘reverse’ Ponseti method with a limited surgical approach to reduce and Kirschner (K)-wire the talonavicular joint and a percutaneous Achilles tenotomy may be preferable to more extensive surgical releases. In tarsal coalition there is failure of segmentation of adjacent tarsal bones. School-aged children present with hindfoot pain and recurrent ankle sprains. The most common coalitions are talocalcaneal and calcaneonavicular ( Figure 44.4 ). Radiographs, computed tomography (CT) or MRI are used to confirm the diagnosis. Treatment is initially conservative, but if the coalition requires surgical excision this should be performed before degenerative changes develop. Other causes of foot pain in children include the osteo chondroses, in which the radiographic changes are similar to A VN. These ‘heal’ but the change in shape of the a ff ected bone may lead to secondary joint sti ff ness and loss of function. (Sim ilar ‘diseases’ a ff ect the lunate [Kienböck’s] and the capitellum of the humerus [Panner’s].) /uni25CF Freiberg’s osteochondrosis presents with forefoot pain and avascular change in the second metatarsal head. Symptomatic bony spurs and osteochondral fragments may need excision but often it is asymptomatic and seen as an incidental finding on a radiograph. /uni25CF Köhler’s disease presents with dorsal forefoot pain and swelling in young children. The navicular becomes avascu lar with alteration in the ossification process. /uni25CF Sever’s disease (enthesopathy of the calcaneal apoph ysis) presents with heel pain related to activity . Tightness in the calf muscle complex may be a contributing factor. The ‘features’ on a radiograph are, in fact, part of normal growth and de velopment. Flexed, medially curved ‘curly toes’ are common and rarely need treatment. Strapping is ine ff ective. Flexor tenotomy is used when there ar e symptoms or cosmetic concerns. Summary box 44.14 Other foot and ankle conditions /uni25CF /uni25CF /uni25CF /uni25CF

CVT – presents as ‘rocker-bottom’ foot Tarsal coalition – presents as a stiff, painful /f_l at foot Osteochondroses – almost always self-limiting Curly toes are common – most do not need treatment

Other foot and ankle conditions

Most postural deformities such as metatarsus adductus and calcaneovalgus feet improve spontaneously . Congenital vertical talus (CVT) is rare and fre - quently associated with neuromuscular conditions such as ‘rocker-bottom’ foot with dorsal dislocation of the navicular on the talus ( Figure 44.31 ). A ‘reverse’ Ponseti method with a limited surgical approach to reduce and Kirschner (K)-wire the talonavicular joint and a percutaneous Achilles tenotomy may be preferable to more extensive surgical releases. In tarsal coalition there is failure of segmentation of adjacent tarsal bones. School-aged children present with hindfoot pain and recurrent ankle sprains. The most common coalitions are talocalcaneal and calcaneonavicular ( Figure 44.4 ). Radiographs, computed tomography (CT) or MRI are used to confirm the diagnosis. Treatment is initially conservative, but if the coalition requires surgical excision this should be performed before degenerative changes develop. Other causes of foot pain in children include the osteo chondroses, in which the radiographic changes are similar to A VN. These ‘heal’ but the change in shape of the a ff ected bone may lead to secondary joint sti ff ness and loss of function. (Sim ilar ‘diseases’ a ff ect the lunate [Kienböck’s] and the capitellum of the humerus [Panner’s].) /uni25CF Freiberg’s osteochondrosis presents with forefoot pain and avascular change in the second metatarsal head. Symptomatic bony spurs and osteochondral fragments may need excision but often it is asymptomatic and seen as an incidental finding on a radiograph. /uni25CF Köhler’s disease presents with dorsal forefoot pain and swelling in young children. The navicular becomes avascu lar with alteration in the ossification process. /uni25CF Sever’s disease (enthesopathy of the calcaneal apoph ysis) presents with heel pain related to activity . Tightness in the calf muscle complex may be a contributing factor. The ‘features’ on a radiograph are, in fact, part of normal growth and de velopment. Flexed, medially curved ‘curly toes’ are common and rarely need treatment. Strapping is ine ff ective. Flexor tenotomy is used when there ar e symptoms or cosmetic concerns. Summary box 44.14 Other foot and ankle conditions /uni25CF /uni25CF /uni25CF /uni25CF

CVT – presents as ‘rocker-bottom’ foot Tarsal coalition – presents as a stiff, painful /f_l at foot Osteochondroses – almost always self-limiting Curly toes are common – most do not need treatment