The Foot
This chapter describes common foot presentations to primary care, e.g., intoeing, metatarsus adductus, and flat foot. Most of these cases are self-limited conditions and need only observation. You will learn how to identify the conditions that need treatm
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The Foot Amr Abdelgawad and Rami Khalifa
Introduction Normal anatomy of the foot: The foot bones are 7 tarsal bones: Talus, calcaneus, navicular, cuboid, and 3 cuneiforms, 5 metacarpals, and 14 phalanges (2 phalanges in the big toe and 3 in the lateral four toes) (Fig. 9.1). The bony structure of the foot is maintained by multiple ligaments, tendons and muscles. Nomenclature (see also Chap. 1 Introduction): • Forefoot: The anterior part of the foot (metatarsus and phalanges). • Mid foot: The middle part of the foot (navicular, cuboid, and three cuneiforms). • Hindfoot: The posterior part of the foot (talus and calcaneus). There are specific terms for the foot position and deformities (fixed abnormal position): • Supination: Inward rotation of the subtalar joint accompanied by inward rotation of the mid foot and forefoot (Fig. 9.2). • Pronation: Outward rotation of the subtalar joint accompanied by outward rotation of the mid foot and forefoot (Fig. 9.2).
A. Abdelgawad Maimonides Medical Center, Brooklyn, NY, USA R. Khalifa (*) Orthopedic Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA © Springer Nature Switzerland AG 2021 A. Abdelgawad et al. (eds.), Pediatric Orthopedics and Sports Medicine, https://doi.org/10.1007/978-3-030-48138-4_9
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A. Abdelgawad and R. Khalifa Hallux
Distal Middle
Phalanges
Proximal 5th 4th 3rd 2nd 1st
Metatarsals
Medial cuneiform Intermediate cuneiform
Lateral cuneiform Cuboid
Navicular
Tarsals
Talus Calcaneus
Fig. 9.1 Anatomy of the foot
Supination
Pronation
The heel is turned inward
Big toe
Litttle toe Big toe Litttle toe The heel is turned outward
Fig. 9.2 Movement of the subtalar joint. Right foot (seen from the back) in supination (inward rotation) and varus (left picture) and pronation (outward rotation) and valgus (right picture)
9 The Foot
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Fig. 9.3 Different position of the foot
Talipes equinus
Talipes varus
Talipes Calcaneus
Talipes cavus
Talipes valgus
Talipes (foot position) types (Fig. 9.3): • Varus: Inward position of the hindfoot and ankle (the sole of the foot pointing medially). • Valgus: Outward position of the hindfoot and ankle (the sole of the foot pointing laterally). • Equinus: Plantar flexion of the ankle and the foot. • Calcaneus: Dorsiflexion of the ankle and the foot. • Cavus: High arch deformity.
Intoeing Definition • Inward deviation of the child’s foot during walking, one of the most common pediatric complaints related to musculoskeletal system. • Most cases of intoeing represent a normal development and do not need orthopedic referral.
Causes of Intoeing • Foot cause: Metatarsus adductus. • Lower leg cause: Internal tibial torsion (ITT). • Hip cause: Excess femoral anteversion.
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Approach to a Child with Intoeing Four steps are used to assess the child with intoeing: • First: Foot progression angle: It is the assessment of the direction of the foot when the child walks. –– The child should walk about 30 feet. –– It must be a relatively long distance (i
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