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Aims: To verify the importance of podiatric evaluation in patients with Down syndrome for the early diagnosis and treatment of minor orthopaedic problems.
Methods: Case-control study of 50 children affected by Down syndrome (aged 4-10 y) without major orthopaedic malformations compared to 100 healthy children. A complete podiatric examination was performed on all patients and controls.
Results: Children with Down syndrome showed several orthopaedic anomalies including bony deformity of the forefoot (90%), flat foot (60%), isolated calcaneal valgus (24%), knee valgus (22%) and pronated flat foot (16%). These abnormalities were responsible for postural alterations as confirmed by baropodometric examination.
Conclusion: The data demonstrated a greater incidence of minor orthopaedic alterations and suggest the necessity of regular podiatric examinations in the follow-up of this syndrome.
Extra genetic material on chromosome 21 or translation of additional chromosome 21 onto another chromosome. 1 in 600-1000 live births. Increased incidence with increase maternal age (~1 in 32 live births at age 45). Originally described by John Down in 1866.
Variably characterised by small ears, large tongue, flat appearance to face, mongolian slant to eyes, short broad neck, congenital heart disease (may cause death in infancy), hypothyroidism, deafness, intellectual disability, sensory abnormalities, visual impairments, premature aging; muscle hypotonia and ligamentous laxity.
Physical development is delayed.
An arthropathy, clinically similar to juvenile chronic arthritis is common.
Foot involvement:
Hallux abducto-valgus; metatarsus primus adductus; flat pronated feet; shoe fitting problems; abducted gait and wider base of support; Simian crease; abnormal dermatoglyphics.
Gait changes:
Excessive external hip rotation; lack of trunk rotation; wide base of gait; inadequate heel contact during gait; decreased ankle ROM; poor foot clearance during swing phase.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
In in my own totally biased unscientific experience, narrow calcs with relatively wide forefeet making footwear fitting realllllly fun and probs with pre fabricated device fitting
Should anyone be interested in further reading on the podiatric involvement in Down syndrome:
Caselli MA. (2003) Biomechanical management of children and adolescents with Down syndrome: proper diagnosis of biomechanical abnormalities allows for more effective treatment of this condition. Podiatry Management. Issue: April-May.
Selby-Silverstein L, Hillstrom HJ & Palisano RJ. (2001) The effect of foot orthoses on standing foot posture and gait of young children with Down syndrome. NeuroRehabiliation. Vol. 16, pp. 183 – 193.
Foot problems in Down Syndrome
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