Foot pathology

1. SCHOOL OF PROSTHETICS & ORTHOTICS
SPECIAL ORTHOTIC SCIENCE
PATHOLOGY OF THE FOOT (PES ADDUCTUS)
5/13/2018 PREPARED BY: MD.ASADUL ISLAM
3RD YEAR; ROLL:07

2. FOOT PATHOLOGY (PES ADDUCTUS)
 PES ADDUCTUS
 “Pes Adductus is a congenital
deformity in which forefoot
appears in adduction from
the line to Linsfranc joint”.
 “ Pes adductus is a deformity at
Lisfranc’s joint in pure transverse plane.
It is spontaneously corrected in
few months for majority of newborns”
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3. FOOT PATHOLOGY (PES ADDUCTUS)
Pes Adductus
 Can be Bilateral or Unilateral
 Lateral border of foot convex
 Medial border of foot concave
 Base of fifth metatarsal (styloid) often
prominent
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4. FOOT PATHOLOGY (PES ADDUCTUS)
Alternative Names
 Metatarsus varus;
 Forefoot varus;
 Metatarsus adductovarus;
 Metatarsus supinatus;
 Forefoot adductus;
 Hooked forefoot
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5. FOOT PATHOLOGY (PES ADDUCTUS)
Classification:
 Mild (flexible deformity)
 Moderate (fixed deformity)
 Severe (rigid deformity)
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6. FOOT PATHOLOGY (PES ADDUCTUS)
Management
 Category A: Mild/flexible deformity
(Most common)
 Parents Stretch child's foot
 Firmly stabilize heel
 Stretch forefoot laterally (everting foot)
 Hold for count of 5 (baby will wince,not cry)
 Do for 5 repetitions at each diaper change
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7. FOOT PATHOLOGY (PES ADDUCTUS)
Management
• Category B: Moderate/fixed deformity
• Evaluation by pediatric specialist
• Serial corrective casts
• Cast every 1 -2 weeks for 3 -4 casts
• Avoid casting too late (after 4- 6 months)
• Late casting is more difficult due to stiff foot
• Child also kicks more at older age
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8. FOOT PATHOLOGY (PES ADDUCTUS)
 Category C: Severe/rigid deformity (rare)
– Serial casts in first few weeks of life
• Takes advantageous of neonates ligament
laxity
– Corrective Surgery if above not effective (2-4yo)
• Age <7: Soft tissue release tarsometatarsal
joint
• Age >7: Metatarsal Osteotomy
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9. FOOT PATHOLOGY (PES ADDUCTUS)
CAUSES
 Metatarsus adductus is thought to be caused
by the infant's position inside the womb.
Risks may include:
 The baby's bottom pointed down in the
womb (breech position)
 The mother had a condition called
oligohydramnios, in which she did not
produce enough amniotic fluid
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10. FOOT PATHOLOGY (PES ADDUCTUS)
CAUSES
 There may also be a family history of the
condition.
 Metatarsus adductus is a fairly common
problem. It is one of the reasons why people
develop "in-toeing."
 Newborns with metatarsus adductus may also
have a problem called developmental dysplasia
of the hip (DDH), in which the thigh bone slips
out of the hip socket.
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11. FOOT PATHOLOGY (PES ADDUCTUS)
Symptoms
 The front of the foot is bent or angled in
toward the middle of the foot. The back of
the foot and the ankles are normal. About
half of children with metatarsus adductus
have the problem in both feet.
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12. FOOT PATHOLOGY (PES ADDUCTUS)
Exam & Test
 Physical examination is all that is needed to
diagnose metatarsus adductus.
 A careful exam of the hip should also be
done to rule out other causes of metatarsal
adductus.
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13. FOOT PATHOLOGY (PES ADDUCTUS)
TREATMENT
 Stretching exercises may be needed. These
are done if the foot can be easily moved into
a normal position. The family will be taught
how to do these exercises at home.
 Your child may need to wear a splint or
special shoes, called reverse-last shoes, for
most of the day. These shoes hold the foot in
the correct position.
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14. FOOT PATHOLOGY (PES ADDUCTUS)
 Orthotic solution
 Case of use
 Postural measures
 Preventive treatment
 Starting treatment when patient gets 3 or 4 weeks old
 Can be combined with other alternative treatment
 Don't sleep in prone position or "face down“
 Manipulations
 Preventive treatment
 Starting treatment immediately at birth; with or without any other
treatment
 Manipulations always should be done by experts
 with or without any other treatment
 Manipulations always should be done by experts
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15. FOOT PATHOLOGY (PES ADDUCTUS)
 Tapping
 Preventive treatment
 Between 1 and 6 months old baby
 Can be combined with other alternative treatment
 Use in slight cases
 Plaster cast
 Preventive treatment
 Between 1 and 6 months old baby
 Use in moderate cases
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16. FOOT PATHOLOGY (PES ADDUCTUS)
 Straight last shoes
 Corrective treatment
 Start treatment when the patient begins to walk
 Can be combined with thermoplastic night splint
 Jointed boot "Bebax"
 Corrective treatment
 Between 1 and 9 months old babies
 All treatment variations of metatarsus adductus and
talipes
 Use in severe cases
 3 planes modification
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17. FOOT PATHOLOGY (PES ADDUCTUS)
 AFO with or without mediotarsal joint
 Corrective treatment
 Between 1 and 9 months old babies
 Use in severe cases
 Only on transversal plane modification
 Thermoplastic night splint with progressive
correction (Turbocast)
 Corrective treatment
 Apply this treatment until the baby is 6 months old
 Can be combined with manipulation, tapping and shoes
 Use only during the night
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18. FOOT PATHOLOGY (PES ADDUCTUS)
 Custom insole
 Corrective and Palliative treatment
 Start treatment when patient gets 2 years old
 Can be used with straight last shoes, manipulation
and splint with progressive correction during the
night
 Anti- varus splint
 Corrective treatment
 When the patient present the pes adductus caused
by a varus tibia
 Between 6 and 9 months old baby
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19. FOOT PATHOLOGY (PES ADDUCTUS)
Possible Complications
 A small number of infants with metatarsus
adductus may have developmental dislocation
of the hip.
Outlook (Prognosis)
 The outcome is almost always excellent. Nearly
all patients eventually have a normal looking
and working foot.
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20. FOOT PATHOLOGY (PES ADDUCTUS)
 Differential Diagnosis
 In-Toeing
 Femoral Anteversion
 Internal Tibial Torsion
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21. FOOT PATHOLOGY (PES ADDUCTUS)
IN-TOEING
In word ending of the toes
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22. FOOT PATHOLOGY (PES ADDUCTUS)
 C. 3 main causes
 (i) metatarsus adductus
 (ii) internal tibial torsion
 (iii) excessive femoral anteversion
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23. FOOT PATHOLOGY (PES ADDUCTUS)
 IN TOEING
I. METATARSUS ADDUCTUS
• normal hindfoot,
 medially deviated
 midfoot
• diagnosis made if
 lateral aspect of foot
 has “C” shape, rather
 than straight
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24. FOOT PATHOLOGY (PES ADDUCTUS)
 In Toeing
ii) Internal Tibial Torsion
• usually presents by
 walking age
• knee points forward,
 while feet point
 inward
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25. FOOT PATHOLOGY (PES ADDUCTUS)
 In Toeing
iii) Execessive Femoral Anteversion
• both knees and feet
 point inward
• presents during early
 childhood (3-7yrs)
• most common cause
 of in-toeing
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26. FOOT PATHOLOGY (PES ADDUCTUS)
 iii) Execessive Femoral Anteversion
• int rotation 70-80 deg
 ext rotation 10-30 deg
• “W” position
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27. FOOT PATHOLOGY (PES ADDUCTUS)
REFERENCES
 www.google.com
 http://www.nycpm.edu/surgclub/metatars
us.pdf
 http://www.nytimes.com/health/guides/di
sease/metatarsus-adductus/overview.html
 BHPI Library
 Essential Orthopaedic & Apply
physiotherapy -Book
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28. THANK
YOU
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