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Questions and Answers
In cases of metatarsus adductus, before what age is non-operative treatment considered MOST ideal?
In cases of metatarsus adductus, before what age is non-operative treatment considered MOST ideal?
- 36 months
- 6 months
- 24 months
- 15 months (correct)
What characteristic distinguishes metatarsus adductus (MA) from adductus of the forefoot (AF)?
What characteristic distinguishes metatarsus adductus (MA) from adductus of the forefoot (AF)?
- AF presents with a more severe deformity clinically.
- MA is characterized by mild adduction of the MT bases.
- MA shows more significant adduction both radiographically and clinically. (correct)
- AF is only identifiable through radiographic assessment.
Which plane of deformity is MOST associated with simple metatarsus adductus?
Which plane of deformity is MOST associated with simple metatarsus adductus?
- Sagittal plane
- Oblique plane
- Transverse plane (correct)
- Coronal plane
What additional plane of deviation is present, along with adduction, in metatarsus adductovarus?
What additional plane of deviation is present, along with adduction, in metatarsus adductovarus?
Complex metatarsus adductus is also known as:
Complex metatarsus adductus is also known as:
Which of the following is NOT typical of cavoadductovarus?
Which of the following is NOT typical of cavoadductovarus?
According to the content, what factor is MOST important to consider when classifying metatarsus adductus to determine the best course of treatment?
According to the content, what factor is MOST important to consider when classifying metatarsus adductus to determine the best course of treatment?
What does a 'fixed and rigid' presentation of metatarsus adductus indicate regarding prognosis?
What does a 'fixed and rigid' presentation of metatarsus adductus indicate regarding prognosis?
In the context of forefoot position in metatarsus adductus, where is concavity typically observed?
In the context of forefoot position in metatarsus adductus, where is concavity typically observed?
What characterizes forefoot adductovarus?
What characterizes forefoot adductovarus?
In the context of rearfoot position, which of the following is NOT typically associated with metatarsus adductus?
In the context of rearfoot position, which of the following is NOT typically associated with metatarsus adductus?
What is a key characteristic of transitional lesions in the context of metatarsus adductus and talipes equinovarus (TEV)?
What is a key characteristic of transitional lesions in the context of metatarsus adductus and talipes equinovarus (TEV)?
What additional condition is present in 'forefoot adduction plus fixed heel inversion/supination' EXCEPT ankle equinus?
What additional condition is present in 'forefoot adduction plus fixed heel inversion/supination' EXCEPT ankle equinus?
What condition is functional metatarsus adductus MOST likely classified as?
What condition is functional metatarsus adductus MOST likely classified as?
What is the approximate incidence of metatarsus adductus in live births?
What is the approximate incidence of metatarsus adductus in live births?
Which of the following factors is classified as an etiology of Metatarsus Adductus?
Which of the following factors is classified as an etiology of Metatarsus Adductus?
Which of the following is an example of 'Position of Comfort' that can result in metatarsus adductus?
Which of the following is an example of 'Position of Comfort' that can result in metatarsus adductus?
Talipes equinovarus may be nothing more than a congenital forefoot varus.
Talipes equinovarus may be nothing more than a congenital forefoot varus.
Which of the following is associated with skewfoot?
Which of the following is associated with skewfoot?
What is the MOST critical factor for a successful prognosis in non-operative treatment of metatarsus adductus?
What is the MOST critical factor for a successful prognosis in non-operative treatment of metatarsus adductus?
Rigid forms of metatarsus adductus respond better to which type of treatment?
Rigid forms of metatarsus adductus respond better to which type of treatment?
When is surgical repair considered in the management of metatarsus adductus?
When is surgical repair considered in the management of metatarsus adductus?
What is a characteristic clinical sign observed in patients with metatarsus adductus?
What is a characteristic clinical sign observed in patients with metatarsus adductus?
In metatarsus adductus, what is the position of the heel?
In metatarsus adductus, what is the position of the heel?
What is a defining characteristic of the first interdigital space in a foot with metatarsus adductus?
What is a defining characteristic of the first interdigital space in a foot with metatarsus adductus?
In the context of metatarsus adductus, where is the apex of concavity located along the medial border of the foot?
In the context of metatarsus adductus, where is the apex of concavity located along the medial border of the foot?
What observation can indicate the severity of the deformity?
What observation can indicate the severity of the deformity?
What finding suggests a flexible variant of metatarsus adductus during examination?
What finding suggests a flexible variant of metatarsus adductus during examination?
In metatarsus adductus, how does the movement typically respond when the lateral border of the foot is stroked?
In metatarsus adductus, how does the movement typically respond when the lateral border of the foot is stroked?
What anatomical feature is unique in metatarsus adductus, causing the first metatarsal to be carried into an adducted position?
What anatomical feature is unique in metatarsus adductus, causing the first metatarsal to be carried into an adducted position?
What is the most common reason why surgical intervention is needed in pes adductus?
What is the most common reason why surgical intervention is needed in pes adductus?
What radiographic finding is expected regarding the RF (rearfoot) in metatarsus adductus?
What radiographic finding is expected regarding the RF (rearfoot) in metatarsus adductus?
If lines are crossing in the midfoot on the radiograph, what does this indicate?
If lines are crossing in the midfoot on the radiograph, what does this indicate?
What is the theory behind spontaneous correction in infants with metatarsus adductus?
What is the theory behind spontaneous correction in infants with metatarsus adductus?
What is the reasoning mentioned for a radiograph?
What is the reasoning mentioned for a radiograph?
What is the recommendation for follow up after casting, with SHOES?
What is the recommendation for follow up after casting, with SHOES?
Surgical intervention is desired in metatarsus adductus, but is it ALWAYS indicated?
Surgical intervention is desired in metatarsus adductus, but is it ALWAYS indicated?
Why are Thompson procedures not done anymore?
Why are Thompson procedures not done anymore?
True or False: Tendons have a habit of going back to where they came from. Therefore if you perform metatarsal adductus surgery, the tendon may retreat and the surgery may not last over time.
True or False: Tendons have a habit of going back to where they came from. Therefore if you perform metatarsal adductus surgery, the tendon may retreat and the surgery may not last over time.
Before what age is early intervention and non-operative treatment considered ideal for correcting Metatarsus Adductus?
Before what age is early intervention and non-operative treatment considered ideal for correcting Metatarsus Adductus?
Metatarsus Adductus (MA) and Adductus Forefoot (AF) both indicate the same degree of overall forefoot adduction.
Metatarsus Adductus (MA) and Adductus Forefoot (AF) both indicate the same degree of overall forefoot adduction.
In the Agnew classification of Metatarsus Adductus, what is the defining characteristic of the most common type, Simple Metatarsus Adductus?
In the Agnew classification of Metatarsus Adductus, what is the defining characteristic of the most common type, Simple Metatarsus Adductus?
In Metatarsus Adductovarus, in addition to adduction of the metatarsals, there is also a ______ plane varus rotation of the forefoot.
In Metatarsus Adductovarus, in addition to adduction of the metatarsals, there is also a ______ plane varus rotation of the forefoot.
Match the Metatarsus Adductus classification with its corresponding characteristic:
Match the Metatarsus Adductus classification with its corresponding characteristic:
Which statement is true regarding Cavoadductovarus?
Which statement is true regarding Cavoadductovarus?
In cases of fixed and rigid metatarsus adductus, attempts to manually reduce and over-correct the deformity are more likely to be successful.
In cases of fixed and rigid metatarsus adductus, attempts to manually reduce and over-correct the deformity are more likely to be successful.
What physical finding along the medial side of the foot is indicative of forefoot adduction?
What physical finding along the medial side of the foot is indicative of forefoot adduction?
In forefoot varus, the deformity presents in the ______ plane.
In forefoot varus, the deformity presents in the ______ plane.
Match the rearfoot position with the associated foot condition:
Match the rearfoot position with the associated foot condition:
What does forefoot adduction plus fixed heel inversion/supination suggest?
What does forefoot adduction plus fixed heel inversion/supination suggest?
Forefoot adduction plus ankle equinus with heel varus is a common presentation.
Forefoot adduction plus ankle equinus with heel varus is a common presentation.
Functional Metatarsus Adductus may be better classified as what other condition?
Functional Metatarsus Adductus may be better classified as what other condition?
The incidence of Metatarsus Adductus is approximately 1 in every ______ live births.
The incidence of Metatarsus Adductus is approximately 1 in every ______ live births.
Match each term with its description relevant to Metatarsus Adductus:
Match each term with its description relevant to Metatarsus Adductus:
What finding suggests that Talipes Equinovarus may be present on one side with Metatarsus Adductus on the contralateral side?
What finding suggests that Talipes Equinovarus may be present on one side with Metatarsus Adductus on the contralateral side?
Casting Metatarsus Adductus is responsible for creating Skewfoot.
Casting Metatarsus Adductus is responsible for creating Skewfoot.
When is the best time to treat Metatarsus Adductus non-operatively, assuming it does not spontaneously resolve?
When is the best time to treat Metatarsus Adductus non-operatively, assuming it does not spontaneously resolve?
In the clinical picture of Metatarsus Adductus, the medial border of the foot has a ______ and the lateral border of the foot has a ______.
In the clinical picture of Metatarsus Adductus, the medial border of the foot has a ______ and the lateral border of the foot has a ______.
Match the radiographic finding with its description in Metatarsus Adductus:
Match the radiographic finding with its description in Metatarsus Adductus:
Why is it not a good idea to do nothing when a patient presents with a significant deformity?
Why is it not a good idea to do nothing when a patient presents with a significant deformity?
Shoes are the primary method of correction in Metatarsus Adductus.
Shoes are the primary method of correction in Metatarsus Adductus.
What specific action is performed during manipulation for serial casting of Metatarsus Adductus?
What specific action is performed during manipulation for serial casting of Metatarsus Adductus?
The fundamental laws of bone and cartilage remodeling state that bone and cartilage grow more slowly when subjected to ______ load.
The fundamental laws of bone and cartilage remodeling state that bone and cartilage grow more slowly when subjected to ______ load.
What must be present to succeed with the technique?
What must be present to succeed with the technique?
A 5-year-old child presents with persistent hallux varus despite previous cast therapy. What is the most appropriate next step in management?
A 5-year-old child presents with persistent hallux varus despite previous cast therapy. What is the most appropriate next step in management?
Which of the following is a complication unique to the Berman-Gartland procedure compared to the Heyman-Herndon-Strong procedure?
Which of the following is a complication unique to the Berman-Gartland procedure compared to the Heyman-Herndon-Strong procedure?
A neonate is diagnosed with postural metatarsus adductus. Which characteristic is true for this condition?
A neonate is diagnosed with postural metatarsus adductus. Which characteristic is true for this condition?
A 6-year-old child presents with complex metatarsus adductus. Which radiographic finding is expected in this condition?
A 6-year-old child presents with complex metatarsus adductus. Which radiographic finding is expected in this condition?
A 2-year-old child with a history of oligohydramnios presents with talipes equinovarus. Which associated condition is most likely to be present?
A 2-year-old child with a history of oligohydramnios presents with talipes equinovarus. Which associated condition is most likely to be present?
Flashcards
Metatarsus Adductus (MA)
Metatarsus Adductus (MA)
MA is a distinct deformity with more adduction, noted radiographically and clinically.
Simple Metatarsus Adductus
Simple Metatarsus Adductus
All metatarsals are adducted at the Lisfranc level; FF adduction plane is parallel to weight-bearing surface. A true one plane (transverse plane) deformity.
Metatarsus Adductovarus
Metatarsus Adductovarus
Two-plane deformity with metatarsals adducted (transverse plane) and frontal plane varus rotation of the forefoot.
Cavoadductovarus
Cavoadductovarus
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Fixed and Rigid Metatarsus Adductus
Fixed and Rigid Metatarsus Adductus
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Easily Reducible Metatarsus Adductus
Easily Reducible Metatarsus Adductus
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Forefoot Position in MA
Forefoot Position in MA
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FF Adductus (ForeFoot)
FF Adductus (ForeFoot)
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FF Adductovarus
FF Adductovarus
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FF Varus
FF Varus
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Rearfoot Position Associations
Rearfoot Position Associations
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Transitional Lesions
Transitional Lesions
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Functional Metatarsus Adductus
Functional Metatarsus Adductus
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Wide First Interdigital Space
Wide First Interdigital Space
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Medial Border of the Foot
Medial Border of the Foot
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Lateral Border of the Foot
Lateral Border of the Foot
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Deep Medial Skin Crease
Deep Medial Skin Crease
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Rigid Form of MA
Rigid Form of MA
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Flexible Form of MA
Flexible Form of MA
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Failure of Active Overcorrection
Failure of Active Overcorrection
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Metatarsal Alignment in MA
Metatarsal Alignment in MA
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1st Metatarsocuneiform Segment in MA
1st Metatarsocuneiform Segment in MA
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Abductor Hallucis Issues
Abductor Hallucis Issues
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Joint Surfaces in MA
Joint Surfaces in MA
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Increased MT Adductus Angle
Increased MT Adductus Angle
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Talometatarsal Angle Abnormal
Talometatarsal Angle Abnormal
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Anterior Surface of First Cuneiform
Anterior Surface of First Cuneiform
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Bebax Shoes
Bebax Shoes
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Patient selection criteria
Patient selection criteria
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Tincture of Benzoin
Tincture of Benzoin
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Outflare last shoes
Outflare last shoes
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Criteria to look for reduction
Criteria to look for reduction
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Thompson procedure
Thompson procedure
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Transfer Abductor Hallucis considerations
Transfer Abductor Hallucis considerations
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Berman-Gartland Procedure
Berman-Gartland Procedure
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Steytler-Van der Walt
Steytler-Van der Walt
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Major overhauls requirements
Major overhauls requirements
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Tarso-metatarsal release
Tarso-metatarsal release
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Rigid vs Flexbile Form TX
Rigid vs Flexbile Form TX
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MA treatment timeframe
MA treatment timeframe
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Cavoadductovarus timeframe
Cavoadductovarus timeframe
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Fixed MA prognosis
Fixed MA prognosis
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Supple MA challenge
Supple MA challenge
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Heel Bisection
Heel Bisection
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FF Adductus
FF Adductus
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FF Adductovarus planes
FF Adductovarus planes
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Rearfoot position check
Rearfoot position check
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Underlying issue in Transitional Lesions
Underlying issue in Transitional Lesions
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Functional MA origin
Functional MA origin
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Medial structure of distal foot
Medial structure of distal foot
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Rigid passive movement
Rigid passive movement
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Clinical Picture of Metatarsus Adductus
Clinical Picture of Metatarsus Adductus
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Where do simons lines cross
Where do simons lines cross
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Hallucis
Hallucis
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Should you do nothing
Should you do nothing
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Can be used with
Can be used with
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real management
real management
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Medico Legal Documentation
Medico Legal Documentation
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Described as Crescentic
Described as Crescentic
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Study Notes
Agnew Classification & Berg
- Distinguishes Simple vs Complex types depending on structures involved
Postural Metatarsus Adductus
- Forefoot can be manipulated to neutral with ease and spontaneous correction is likely
Congenital Metatarsus Varus
- Medial subluxation or TMJ complexes are noted where NOT subluxed, they are congruent
- Bone distal to the joint is misshapen (bending in the bone near the met base or in the shaft)
Rearfoot & Tarsal Relationships
- Hindfoot neutral or slightly everted, TNJ normal
the metatarsus
- The metatarsus & Talometatarsal angle (Simons' angle) assessed for severity
Radiological Aspects
- AP talocalcaneal angle (Kite's angle) assessed where: Normal- 20-35 degrees
- Lateral talocalcaneal angle: Normal- 25-45 degrees
Definite Indications for Surgical Intervention
- Persisting hallux varus is a key indication that the abductor hallucis is either contracted or malinserted.
- Non surgical treatment of this presents mainly in children over the age of 3 where After age 3, the success rate of cast therapy is so small that it probably should not be attempted
- The skeletal age suggests that there is insufficient cartilage remodeling to take place by casting alone
- Large physical size presents difficulties in cast
- Late recurrence & Failure of nonoperative therapy will influence treatment
- No surgery is indicated for metatarsus adductus until an effort to correct the deformity nonoperatively has failed
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