75 old STG Pediatric Flexible Flatfoot 2022.pdf

Infants are usually born with a flatfoot Normal arch does not develop until about 7 to 10 years old 3 Foot shape is dynamic Lin et al Natural history of feet in preschool children o Decrease in the incidence of flexible flatfoot including severity with age o Moderate-severe flatfeet ▪ 57% at age 2 t...

Infants are usually born with a flatfoot Normal arch does not develop until about 7 to 10 years old 3 Foot shape is dynamic Lin et al Natural history of feet in preschool children o Decrease in the incidence of flexible flatfoot including severity with age o Moderate-severe flatfeet ▪ 57% at age 2 to 3 years ▪ 21% at age 5 to 6 years 4 5 6 History of Present Illness What is the specific concern? Who is concerned? When does it manifest? Duration? Improving or worsening? 7 Medical History Medical History Milestones/Developmental delay(s)? Precipitating event/birth complication? Family History 8 Developmental History 1. Gross Motor: e.g. sitting and walking 2. Fine Motor: e.g. Pincer grasp and scribble 3. Language: e.g. say “mama”“baba”and two words sentence 4. Social: e.g. smiling, playing with others Relationships with siblings, peers, adults. School grade and performance, behavioral problems, ACTIVITIES 9 Size and Gender Height and Weight Increase size = Increase risk Gender Boys higher risk than girls 10 Flexible Flatfoot 15-20% adults have flexible pes planus (most asymptomatic) Risk factors Overweight Male Equinus Hypermobility syndromes o Marfan o Ehlers-Danlos o Benign Hypermobility 11 The Work Up Sagittal Plane Equinus Hamstring Iliopsoas Frontal Plane Genuvalgum Forefoot varus Limb length discrepancy Transverse Plane Femoral antetorsion Internal femoral position Internal tibial torsion 12 PHYSICAL EXAM GAIT ANALYSIS 1. NORMAL, ANTALGIC, NEUROMUSCULAR 2. LINE OF PROGRESSION, STJ POSITION 3. TIP-TOE AND HEEL WALK 4. SHOULDER DROP 5. “NORMAL” WALK 13 Leg/Knee position Genu Valgum Genu Varum 14 “Too many toes” 45 3 2 1 12 34 15 HEEL RAISE 16 Equinus = Midfoot hypermobility 17 Proper assessment 18 Jack’s Test AKA Hubscher maneuver 19 Windlass mechanism 20 RADIOGRAPHIC FINDINGS 21 22 23 Flexible Flatfoot Nonsurgical treatment Orthotics AFO Physical therapy Dynamic stretching device/brace 24 Flexible Flatfoot Surgical Treatment Arthroeresis Calcaneal osteotomy o Evans o Medial displacement Medial column osteotomy Arthrodesis Deforming Factors Kidner Gastrocnemius recession 25 Arthroeresis 26 SYMPTOMATIC PATHOLOGIC FLATFOOT SURGICAL OPTIONS OSTEOTOMY FUSION SOFT TISSUE 27 Evans Calcaneal Osteotomy 28 Calcaneal osteotomies 29 1 month post-op 30 31 32 Accessory Navicular History First described Bauhin (1605) Von Lushka (1858) –German Anatomist 17 yr old boy—tarsal scaphoid & accessory ossicle joint like & bound by capsule AKA: Accessory scaphoid Pre-hallux Os tibiale externum Os naviculare secundarium Navicular secundum Gorilloid navicular Kidner Foot 33 Accessory Navicular Incidence 2-21% ½ of cases will fuse to navicular Navicular development Present 2nd fetal month Ossifies ~ 9-11yrs old Demographics Women>Men Bilateral in 50-90% cases 34 Accessory Navicular Type I (30%) Separate Type II (50-60%) Synchondrosis Type III (10-20%) Fusion 35 Accessory Navicular Non-surgical treatment Relieve pressure NSAIDS Shoe Modification UCBL Short Leg walking cast 36 Accessory Navicular Surgical treatment Kidner (1929) o Excision and reattachment of PT tendon ORIF of accessory bone Percutaneous drilling Treat comorbidities Flexible flatfoot Equinus 37 38 39 40 41 42 43 Thank you! 44