Pediatric Foot Alignment Deformities

Excerpt

Pediatric foot alignment deformities include a wide range of entities that can be simple or complex. The deformities can present at birth or later in life and, in some cases, are diagnosed in utero. The parents seek medical care for their children with these conditions. The most common deformities are clubfoot, planovalgus foot, cavovarus foot, congenital vertical talus, congenital oblique talus, metatarsus adductus, and skew foot deformity.

Clubfoot: Clubfoot (talipes equinovarus) is a congenital idiopathic foot deformity. Clubfoot is one of the most common congenital foot deformities and can lead to severe disability if left untreated. The malformation consists of 4 components outlined with the mnemonic CAVE (Cavus, Adductus, Varus, Equinus). Clubfoot demonstrates excellent outcomes if treated early; the most commonly used management is the Ponseti method of serial casting.

Planovalgus: Pes planovalgus deformity (flatfoot deformity) is a relatively common orthopedic condition that usually presents in adolescence. This deformity is characterized by midfoot planus and hindfoot valgus deformity. The diagnosis is usually made clinically, although imaging can be pursued to exclude other coexisting conditions.

Cavovarus: Pes cavovarus is a common orthopedic condition affecting children and adults. Cavovarus and cavus deformity are usually used interchangeably as the cavus foot, most commonly, is presented with varus hindfoot deformity. This condition is generally associated with neurological disorders and can occur after trauma. On physical exam, midfoot cavus (ie, foot arch higher than normal) and hindfoot varus are described. Diagnosis is mainly clinical; treatment options range from foot orthotics to surgical intervention.

Congenital vertical talus: Congenital vertical talus (CVT) is a rare congenital condition characterized by rigid dorsal talonavicular dislocation. Chromosomal or neuromuscular abnormalities are usually the cause. Patients with CVT present with rigid flatfoot deformity. If not treated early, CVT may lead to significant disability.

Congenital oblique talus: Congenital oblique talus (COT) is an uncommon pediatric foot deformity and should be distinguished from congenital vertical talus, as they have the same clinical picture. COT may be considered a normal anatomic variant.

Metatarsus adductus: Metatarsus adductus (MA) is the most common congenital deformity of the foot in newborns and is present in 1 to 2 babies per 1000 births. This deformity is isolated to the forefoot, with a medial deviation of the metatarsals at the Lisfranc joint. The exact etiology remains unknown; up to 90% of fully flexible metatarsus adductus cases resolve spontaneously by one year of age.

Skew foot: Skewfoot is a rare pediatric foot deformity characterized by forefoot adduction, midfoot abduction, and hindfoot valgus deformity, forming a characteristic “z” appearance of the foot. The etiology varies; congenital and acquired have been identified. Treatment is usually surgical.