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I have a fifiteen month old brought in by her mother to assess her feet so they don't become like hers...
Definite 'digital adductus' if not met. All caused by external rotation of the leg as she is in midstance.
My question is-how can serial casting help this if it is caused by the gait pattern? Can anyone give me any suggestions as to how the gait pattern is caused? She has full ROM in the hips etc.
Would a simple Gecko ionsole be of benefit?
Please help me her mother is very caring and wants to help her...
15 months is too old for casting. If it is the toes that are pulling the forefoot medially due to a contracted abductor hallucis muscle, then the Bleck procedure is a simple surgery that will be very helpful at this age.
Only just read this LoL. Twister cables be my favourite
I worked with Herman at OCPM, and I saw some of his twister cable patients. The ones I was did not correct at the hip, as we were told, but rather at the knee and ankle. I would never recommend them to anyone. As far as I am concerned, the patient would be better off with a derotational tibial osteotomy.
Regarding metatarsus adductus, personally, I would not use reverse last shoes on anyone. If the patient is under a year, manipulate (distal traction on LisFranc's joint, palm against the cuboid and manipulate laterally) , and cast for a week. With the wriggly kids (all that I have ever come across), cast proximally first (up to the base of the 5th metatarsal), and then when dry, cast the distal portion and attach it to the proximal portion.
Up until 15 months, if the hallux is adducted on weight bearing, a Bleck procedure will work. (Abductor hallucis tenotomy-I do it right behind the first metatarsal head. Abduct the hallux, make a small incision over it, fish out the tendon with curved hemostats and cut it)
I also would like some guidance re metatarsus adductus. I saw a 4 yo boy recently, the foot is quite flexible ( I can straighten the foot) . asymptomatic, "Mild" deformity in appearance. The mother was wanting to know what could be done (conservatively)
He has been prescribed exercises and swapping shoes by a physiotherapist recently .
In a previous thread, Kevin Kirby, I read that you said you would treat with an orthosis with a lateral heel skive fore-foot valgus wedge correction and medial arch fill. Would that still be the go?
The little boy has Trisomy 8 mosiacism and probably would not stay still for casting. I thought about using premade and modifying them.
I also would like some guidance re metatarsus adductus. I saw a 4 yo boy recently, the foot is quite flexible ( I can straighten the foot) . asymptomatic, "Mild" deformity in appearance. The mother was wanting to know what could be done (conservatively)
He has been prescribed exercises and swapping shoes by a physiotherapist recently .
In a previous thread, Kevin Kirby, I read that you said you would treat with an orthosis with a lateral heel skive fore-foot valgus wedge correction and medial arch fill. Would that still be the go?
The little boy has Trisomy 8 mosiacism and probably would not stay still for casting. I thought about using premade and modifying them.
Sincerely Jill
Jill:
I would not treat the child with metatarsus adductus if there were no gait abnormalities, other symptoms present or functional limitations caused by the foot structure. Don't allow the child's shoes to be "swapped". This can harm the child's foot by putting too much abduction force on the forefoot.
One must remember that metatarsus adductus is a normal variant and only causes problems in more severe cases. One fact that is not understood very well by the podiatry profession is that metatarsus adductus will tend to make the subtalar joint (STJ) less pronated during gait, all other factors being equal, since the more medial location of the metatarsal heads relative to the STJ axis will increase the STJ supination moment and/or decrease the STJ pronation moment from ground reaction force, especially during the latter stages of the stance phase of gait (Kirby, Kevin A: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, October 2001). In other words, maybe if more feet had more metatarsus adductus, we would all see fewer pronated feet in our practices!
Jill, if you can describe more clearly what gait or symptom problems this child currently has, other than just "flexible metatarsus adductus" then I will be able to help you with an orthosis prescription. However, if the child just has a "flexible metatarsus adductus" and no other gait abnormalities or symptoms or functional limitations, then I don't think you need to treat the child at all.
By the way, welcome to Podiatry Arena and Merry Christmas.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Thank you very much for your prompt reply. I'll review the gait and symptoms with what you said in mind.
His diagnosis of Trisomy 8 is recent and his mother is very upset . Being able to allay even a few concerns will be welcome.
Merry Christmas to you -we certainly are merry - lots of rain and a new government.
The latest Podiatry Today has this article:
Point/Counterpoint: Managing Pediatric Metatarsus Adductus: Should You Treat It?
Quote:
Yes, Russell G. Volpe, DPM advocates early treatment for moderate to severe metatarsus adductus, and semi-rigid or rigid deformity. He cites problematic compensatory effects from residual deformities and a documented association between metatarsus adductus and hallux abducto valgus deformity. No, Richard M. Jay, DPM says the deformity does not necessarily require treatment. He emphasizes key criteria in the clinical exam as well as other diagnostic findings for determining the appropriate course of treatment or non-treatment.
Metatarsus adductus Tx
Linear Mode
