L3_Developmental_Flatfoot

Front 1

List the 10 possible causes of pronation in a child.

Back 1

1. In-toed gait
2. Out-toed gait
3. Genu Valgum
4. GenuVarum
5. ForefootVarus
6. STJ Varus
7. Ligamentous Laxity
8. Vertical Talus
9. Tarsal Coalition
10. Talipes Calcaneovalgus

Front 2

How does calcaneal inclination/pitch change from birth to 6 years of age?

Back 2

Increases with age
Parallel at birth
15 degrees at 6 years

Front 3

Why does an infant's foot appear flat?

Back 3

Plantar Fat Pad
Joint Laxity

Front 4

How long does a child's foot appear flat in normal development?

Back 4

about 1-2 years

Front 5

Other than the usual signs of excessive pronation you would see in an adult foot, name two red flags for pathological pronation in a child's foot.

Back 5

1. Abnormal foot position When Non Weightbearing
2. Deformity uncorrectable by Manipulation

Front 6

How does femoral rotation change during development?

Back 6

<6yrs=more ext than int
>6yrs 45:45 balance of ROM

Front 7

How would out-toed gait cause excess pronation?

Back 7

Centre of Gravity is medial to STJ
and is a Deforming Pronatory Force

Front 8

What purpose does a wide base of gait
serve for a young child?

Back 8

Better Balance & Stability

Front 9

What is COXA VALGA?

Back 9

the frontal plane angle formed between the axis of the femoral head and shaft

Front 10

How does coxa valga change during development?

Back 10

It Reduces
newborns=140 degrees
6 years= 128 degrees

Front 11

Increased coxa valga in young children causes a wide ____ of ____.

Back 11

base of gait

Front 12

How long does developmental genu varum persist?

Back 12

from birth until 4 years old

Front 13

In what two groups of children is genu varum seen?

Back 13

- in newborns
- in early walkers

Front 14

What two pathological conditions
prevent genu varum from resolving?

Back 14

1. Blount's disease
2. Rickets

Front 15

What position is the tibia in in genu varum?

Back 15

in varus

Front 16

In what position is the STJ in genu varum?

Back 16

in a varus position

Front 17

The STJ in a varus position will require compensatory ________ if the foot is to reach the ground.

Back 17

pronation

Front 18

State at what developmental stages genu valgum is normally seen.

Back 18

3-8 years
10-12 years

Front 19

Why is there a second stage of genu valgum in girls?

Back 19

puberty
hips widen

Front 20

Explain the physical process that leads to development of genu valgum.

Back 20

Uneven growth of Femoral Condyles
Greater Medial growth causes genu valgum

Front 21

Name three factors that may influence the development of genu valgum

Back 21

1. Trauma
2. Pressure on the epiphysis
3. Child's weight

Front 22

What effect does genu valgum have on foot posture?

Back 22

Combined wide base of gait + genu valgum
shifts bodyweight medially to STJ
and increases pronatory force

Front 23

How do you assess for genu valgum?

Back 23

Put child's legs and feet together
If feet stay apart they have GV

Front 24

How does the Subtalar Joint change
configuration from birth to 6 years?

Back 24

Varus Torque of the talar head derotates by 6 years

Front 25

Values for STJ varus between 0-6 years old?

Back 25

newborn=8-10 degrees
at 6 years=2-4 degrees

Front 26

What is the position of the forefoot in the first 6 years of life?

Back 26

Varus
At Birth = 10-15 degrees
6 yrs = reduces to 2 degrees

Front 27

How does forefoot varus at birth results in excessive pronation in childhood?

Back 27

any degree of forefoot varus will require a compensatory degree of STJ pronation to bring the foot plantigrade

Front 28

What is the most common cause of
flexible paediatric flatfoot?

Back 28

Ligamentous laxity

Front 29

What is the function of ligaments?

Back 29

prevent joint instability
control joint positions when WB

Front 30

At what age does ligamentous laxity peak?

Back 30

2-3 years

Front 31

How does ligamentous laxity change during childhood?

Back 31

Peaks at 2-3yrs and is at adult levels by 10yrs

Front 32

What is the effect on the STJ of ligamentous laxity?

Back 32

Foot appears Flat
Talar head displaces plantarly, medially and anteriorly

Front 33

What is the effect of repeated excessive pronation on the ligaments?

Back 33

Ligaments will Attenuate
and Permanently Deform
=Foot Posture/Function affected

Front 34

At what age is nerve fibre myelination usually complete?

Back 34

6 years of age

Front 35

What is the effect of incomplete neuromuscular maturity on a child's gait?

Back 35

poor coordination

Front 36

Name 5 ways in which the functioning of the neuromuscular apparatus improves during childhood.

Back 36

1. Phasic Muscle Action
2. Muscle Strength
3. Muscle Antagonist Balance
4. Efficient Tendons
5. good propriception

Front 37

In what 2 ways does an immature neuromuscular system
lead to excessive pronation in gait?

Back 37

- Antipronatory Muscles Undeveloped
- Flexed Knees and Hips in gait

Front 38

Define Tarsal Coalition

Back 38

A synchondrosis of two or more tarsal bones
caused by failure of joint development.

Front 39

When do tarsal coalitions become painful?

Back 39

when the synchondroses start to ossify

Front 40

Name 6 symptoms of Tarsal Coalition?

Back 40

1. Reducing ROM
2. Increasing Pain
3. Reduced MLA
4. Heel in Fixed Eversion
5. Peroneal Spasm
6. Recurrent Ankle Sprains

Front 41

Why does tarsal coalition stop normal joint movement?

Back 41

Bridge between bones stops normal articulation

Front 42

Name the three types of coalitions.

Back 42

1. fibrous
2. cartilaginous
3. osseous

Front 43

What percentage of the population has a tarsal coalition?

Back 43

1-4%

Front 44

Name three sites of tarsal coalition.

Back 44

Talo-Calcanceal
Calcaneo-Navicular
Calcaneo-Cuboid

Front 45

What x-ray view is best for seeing tarsal coalitions?

Back 45

oblique views - open up the tarsals

Front 46

Name three possible Ddx for tarsal coalition.

Back 46

1. Degenerative Arthritis
2. Inflammatory Arthritis
3. Subtalar joint Fracture

Front 47

How does a tarsal coalition cause flatfoot position?

Back 47

tarsals motion compensates for Restricted ROM
Ligaments attenuate
MLA flattens
Peroneals shorten

Front 48

What improves/worsens tarsal coalition pain?

Back 48

Relieved by rest.
Aggravated by prolonged activity.

Front 49

Where would a patient report pain if there was a Calcaneonavicular coalition?

Back 49

from the sinus tarsi

Front 50

Pain near the medial facet of the STJ, anterior to the medial malleolus probably means a coalition where?

Back 50

talonavicular joint

Front 51

State three sites of tarsal coalition
and the ages when each ossifies.

Back 51

TaloNavicular 3-5yrs
CalcaneoNavicular 8-12yrs
TaloCalcaneal 12-16yrs

Front 52

Treatment approach to tarsal coalitions?

Back 52

Immobilisation
Rearfoot Neutral
Surgery once ossification complete

Front 53

Describe 4 points about foot alignment in Vertical Talus.

Back 53

1. Rocker Bottom
2. Forefoot Dorsiflexed/Abducted
3. TaloNavicular Dialocation
4. Navicular sitting on Talar Neck

Front 54

What is this condition?

Back 54

Vertical Talus

Front 55

What is this condition?

Back 55

Talipes Calcaneovalgus

Front 56

What 3 interventions are possible for Vertical Talus?

Back 56

1. Manipulation
2. Cast Immobilisation
3. Surgery

Front 57

What gives the Rocker Bottom convex appearance of the MLA in Vertical Talus?

Back 57

the talar head pushing through the plantar surface of the foot

Front 58

What two other areas should you look out for if a child appears to have a Vertical Talus?

Back 58

1. neurological problems
2. chromosomal abnormalities

Front 59

What does the evidence tell us about
surgery to correct Vertical Talus?

Back 59

best undertaken in 1st Year
deformity never entirely corrected

Front 60

Talipes Calcaneovalgus - please define the foot position

Back 60

Entire fore- and rearfoot is
abducted, everted and dorsiflexed
in relation to the leg

Front 61

What pre-birth situation causes Talipes Calcaneovalgus?

Back 61

increased interuterine compression

Front 62

Name the four types of
Talipes Calcaneovalgus deformity.

Back 62

1. Flexible
2. Rigid
3. Structural
4. Positional

Front 63

What is the difference between
flexible and rigid Talipes Calcaneovalgus?

Back 63

Flexible - foot remains corrected briefly
Rigid - foot immediately returns to abnormal position

Front 64

How does Talipes Calcaneovalgus affect gait in a child?

Back 64

Walking Very Difficult
Late Walking Likely

Front 65

Statethe two-stage approach to managing Talipes Calcaneovalgus.

Back 65

1. Daily Passive Stretching
2. Serial Casting (if deformity persists)

Front 66

If a child is In-toeing, what must you first determine?

Back 66

Which body segment is internally rotated.

Front 67

What should you observe to assess the level at which internal rotation is occurring in in-toeing?

Back 67

Patellae Position
Angle of Gait
(are they aligned?)

Front 68

If soft tissue around the hip is responsible for internal femoral torsion, what would you see?

Back 68

Both Angle of Gait and Patella
will face the Same Direction

Front 69

If there was only internal tibial torsion
what would you see on examination?

Back 69

Patellae face forwards, angle of gait inwards

Front 70

What is the main influence on subtalar joint position?

Back 70

The degree of external or internal tibial torsion.

Front 71

Why would in-toeing cause a child to excessively pronate?

Back 71

Child abducts the feet to compensate for tibial or femoral torsion.
CoG falls medial to STJ, pronatory force-->pronation...

Front 72

How does ankle equinus lead to abnormal pronation?

Back 72

The STJ dorsiflexes to compensate for lack of ankle dorsiflexion.

Front 73

In what 3 main circumstances should paediatric flatfoot be treated?

Back 73

If foot is:
1. Not Functioning
2. In Poor Position
3. or Painful

Front 74

What framework is there for assessment and treatment of paediatric flatfoot?
Explain it briefly

Back 74

Traffic Light System
Red - painful, symptomatic
Yellow - abnormal but not painful
Green - developmental only

Front 75

What treatment is indicated for painful, symptomatic flatfoot?

Back 75

M-O-M-S

1. Muscle strengthening/stretching
2. Orthoses
3. Monitor
4. Shoe Therapy

Front 76

What treatment is indicated for
abnormal but asymptomatic flatfoot?

Back 76

M-O-S-S
Monitor
Orthoses
Shoes
Strengthen/Stretch

Front 77

If your patient has developmental flatfoot,
what would your management be?
Why?

Back 77

Reassure parents
Monitor the child's feet
---
Developmental flatfoot resolves with age

Front 78

4 key treatment approach principles for childhood flatfoot?

Back 78

1. Evidence-based
2. SMART goals
3. Pros and cons
4. Review

Front 79

What does the evidence say about
whether orthoses work for excessive pronation?

Back 79

Improve Pain, Position & Fatigue

Front 80

Why are orthoses useless for anyone under 2 years old?

Back 80

children under 2yrs do not have heel-toe motion in gait.

Front 81

What does the evidence say about long term improvement in foot function using orthoses?

Back 81

no evidence to show long term function is improved

Front 82

How long will an orthotic usually last in a child?

Back 82

6mths - 1yr

Front 83

Why might you give exercises to a child with abnormal pronation?

Back 83

strengthen weak antipronatory muscles

Front 84

Define developmental flatfoot

Back 84

A Flexible flatfoot with excessive pronation,
and marked calcaneal eversion on WB

Front 85

Between what ages is developmental flatfoot normal?

Back 85

from birth to 6 years old

Front 86

What is a flexible flatfoot?

Back 86

arch when NWB
no arch when WB
Windlass mechanism=working

Front 87

What is a rigid flatfoot?

Back 87

no arch when NWB or WB

Front 88

What is a synchondrosis?

Back 88

a fibrocartilaginous union between two bones

Front 89

What is another name for Tarsal Coalition?

Back 89

Painful Peroneal Spastic Flatfoot

Front 90

Ideally, when should Talipes Calcaneovalgus be treated?

Back 90

Soon after birth - when the baby's tissues are still malleable