clubfoot - DEOEC Ortopédiai Klinika

The anatomy of the foot. Diseases of the
leg: flat foot, bunion, hammer toe.
Congenital deformities:
clubfoot, vertical talus.
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University of Debrecen
Departement of
Orthopaedic Surgery
26 bones
57 joints
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Joints of the foot
Subtalar
Chopart
Lisfranc
I MTP
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Functions of the foot
•Static functions:
- Lateral column of the foot: calcaneus,
cuboideum, IV, V metatarsus → weight
bearing, support
•Dinamic functions:
- Medial column of the foot: talus, naviculare,
cuneiform I, II, III → walking, energy
absorption
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Construction of the foot
Body weight
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Muscles responsible for holding
the longitudinal arch:
•posterior tibial muscle
•flexor digitorum longus muscle
•flexor hallucis longus muscle
•peroneal muscle
Muscles responsible for holding
the transversal arch :
•adductor hallucis muscle
•long peroneal muscle
•anterior tibial muscle
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Normal versions of the forefoot
Greek
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Egypt
Square
Functional anatomy
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Deformities in the saggital plane
• Pes equinus (talpies equinus):
plantarflexion in the talocrural joint
• Pes calcaneus: the foot is in dorsal
extension
• Pes cavus (excavated foot):
forefoot is in flexion compared to the
hindfoot, high longitudinal arch
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Deformities in the frontal plane
• Pes varus: the calcaneus turns inward at the
subtalar joint
• Pes valgus: the calcaneus turns outward at
the subtalar joint
• Pes adductus (metatarsus varus, intoe): the
forefoot turns medially in the Chopart-joint
• Pes supinatus (inverted foot): the forefoot is
in supination in the Chopart-joint
• Pes abductus: the forefoot turns laterally in
the Chopart-joint
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
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Deformities in clubfoot
-pes
-equino
-varus
-adductus et
-plantiflexus
-congenitus
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
•
•
•
•
Boys: girls = 2:1
Often 2 sided
Prevalence in Europe 1-2 ‰
Etiology: multifactorial = genetic +
environmental factors
• Familial aggregation
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
Cheselden 1768.
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
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Pes equinovarus adductus et
plantiflexus congenitus
(clubfoot)
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IOWA (Ponseti) Clubfoot
Protocol
Igancio Ponseti
Casting technique
Forefoot supination
Holding the head of
the talus laterally
No pronation
No dorsalextension
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IOWA (Ponseti) Clubfoot
Protocol
Igancio Ponseti
Total, horizontal
percutaneous
Achillotomy to correct
the equinus at the 67th week of casting.
Further casting:
15º dorsal extension
70 º abduction
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IOWA (Ponseti) Clubfoot
Protocol
Igancio Ponseti
Postoperative care
Ponseti brace until
the age of 3-4
years.
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Surgical treatment
(Cincinnati incision)
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Surgical treatment
(Cincinnati incision)
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Surgical treatment
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Surgical treatment
(Cincinnati incision)
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Pes adductus
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Pes adductus
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Surgical treatment
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Pes excavatus
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Vertical talus
(Pes calcaneovalgus congenitus)
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Synostosis calcaneo-navicularis,
tarsal coalition
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Developmental diseases
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Fejlődési rendellenességek
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Fejlődési rendellenességek
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Aseptic necrosis of the navicular bone
Köhler I.
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Aseptic necrosis of the head of the II.
metatarsus; Köhler II.
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Calcaneal apophysitis; Morbus Schintz
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Static foot deformities
• Flattened longitudinal arch (flat foot)
• Flattened transversal arch
• Hallux valgus/Bunion
• Other toe-deformities
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Pes planus/
Pes planovalgus/ Calcaneovalgus/
Fallen arch/ Flat foot)
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Pes planus (flat foot)
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Pes planus (flat foot)
•The arches develop until the age of 2-3
•Symptomless in childhood
•The inner side of the shoe is worn off
•Risk: pregnancy, obesity
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Treatment of pes planus (flat foot)
Prevention:
•Walking on uneven surface;
•Pick up the child, when tired;
•Foot-gymnastic
In childhood:
•gymnastic
•shoe sole – supinating wedge
•surgery
Adulthood, in case of complain:
•shoe sole
•surgery
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Pedes transversoplani
(flattened transversal arch)
• Leads to:
– metatarsalgia
– toe deformities (hammer toe, hallux valgus)
• Treatment: gymnastic, shoe sole, surgery
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Pedes transversoplani
(flattened transversal arch)
• Weil OT
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Hallux valgus (Bunion)
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Hallux valgus
• 1. Lateral deviation of
the hallux
• 2. Medial deviation of
the I. MT
• 3. Pronation of the
hallux
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Hallux valgus (Bunion)
Treatment:
• Hallux valgus correction orthesis
• Shoe sole
• Orthopedic shoes
• Surgeries: soft tissue - surgery, removing
exostosis, osteotomies, arthrodesis,
resection arthroplasties
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Surgical solutions
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Surgical solutions
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Surgical solutions
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Hammer toe
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Calcar calcanei
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Haglund heel
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