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The patient is a teenage boy (14yo) with this congenital deformity which did not bother him so far. The problem now (besides the aesthetic issue) is that he can´t find a pair of shoes that fit him well. He doesn´t complain about pain even though his 1st MTT-phalangeal is a bit rigid (plantarwards like hallux rigidus). My questions to you guys:
1 - What exactly is the classification of that deformity?
2 - What is the best surgical option?
I would like very much to know your input!
Thanks,
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Marcos Cajueiro Fernandes
Foot & Ankle Surgery
Hospital Ortopédico de Londrina
Av Duque de Caxias 2575
Cep: 86010-190 - Londrina - PR - Brazil mcajoo@gmail.com
facebook.com/mcajoo
Can you please provide weight bearing laterals and medial obliques?
It appears there is congential coalitions of the navicular, medial cuneiform and 1st metatarsals which is very rare. Couple with this is either coalition or malformation at the hallux IP joints. This has shortened the medial column considerably, and possibly contributed to the adductus of the hallux and lesser digits.
Are there other congenital physical, developmental or learning issues? Has a paediatrician excluded other syndromes?
Great case, please post more images!
LL
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No other syndromes that I know of... I didn´t send all the X-Rays because the forum only allowed 4 images - here are the other ones.
You´re right - there is congenital coalitions of the navicular, medial cuneiform and 1st metatarsals and I have never heard of it, nor found it in the literature yet - do you know if there is a description of it somewhere?
Thanks for the reply!
__________________
Marcos Cajueiro Fernandes
Foot & Ankle Surgery
Hospital Ortopédico de Londrina
Av Duque de Caxias 2575
Cep: 86010-190 - Londrina - PR - Brazil mcajoo@gmail.com
facebook.com/mcajoo
I've seen very similar feet and never do know what pigeon hole to place them into. It is a mild metadductus but most of the deformity is transverse plane at the MTPJs. The ones I've seen also have very tight TAs and very little motion at lisfrancs, particularly the 1st met-cun..
Surgically you can realign the 1st MTPJ without shortening it too much (wedge at the neck) and do a modified Weil at the second to shorten slightly and realign this as well. You may need a TA lengthening as well.
The question is always _ is surgery indicated?
My feeling is always to limit surgery to fulfilling two criteria; decrease pain and improve function. If he is asymptomatic then you have to decide on a case by case basis.
Custom shoes are always an option.
Good luck
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
The Following 2 Users Say Thank You to drsarbes For This Useful Post:
I've seen very similar feet and never do know what pigeon hole to place them into. It is a mild metadductus but most of the deformity is transverse plane at the MTPJs. The ones I've seen also have very tight TAs and very little motion at lisfrancs, particularly the 1st met-cun..
Surgically you can realign the 1st MTPJ without shortening it too much (wedge at the neck) and do a modified Weil at the second to shorten slightly and realign this as well. You may need a TA lengthening as well.
The question is always _ is surgery indicated?
My feeling is always to limit surgery to fulfilling two criteria; decrease pain and improve function. If he is asymptomatic then you have to decide on a case by case basis.
Congenital foot deformity
Linear Mode
