Table of Contents

• Kohler’s Disease
• Curly Toes
• Polydactyly
• Congenital Hallux Varus
• Overlapping Toe
• Accessory Navicular
• Habitual Toe Walking
• Ball and Socket Ankle
• Juvenile Bunions
• Iselin’s Disease
• Sever’s Disease

Kohler’s Disease

• Gender Prevalence: Boys > Girls
• Cause: Idiopathic avascular necrosis (AVN) of the navicular bone.
• Development: Navicular is the last bone to ossify in the foot.
• Symptoms: Pain, limping, weight-bearing on the lateral border of the foot.
• Natural History: Navicular reconstitutes naturally within 18 months; symptoms improve before that.
• Treatment: Short period of restricted weight-bearing with a plaster cast.

Curly Toes

• Cause: Contracture of the flexor digitorum longus (FDL) or flexor digitorum brevis (FDB), usually affecting the lateral three toes.
• Treatment: Tenotomy of FDL around age 3 if symptomatic.

Polydactyly

• Description: Presence of extra toes, commonly on the lateral (post-axial) side.
• Family History: Often positive.
• Associated Conditions: Linked with congenital hallux varus.
• Treatment: Typically, the most lateral toe is removed, considering both bony and soft tissue components. Optimal age for surgery is around 9-12 months.

Congenital Hallux Varus

• Associated Conditions: Linked with polydactyly.
• Anatomy: Short, thick first metatarsal (MT); adductor hallucis longus is the deforming muscle.
• Treatment: Rarely requires surgery; if indicated, involves release of adductor hallucis longus and possibly osteotomy.

Overlapping Toe

• Description: Usually affects the 5th toe overlapping the 4th toe.
• Symptoms: May cause issues with footwear.
• Treatment Options:
  • Stretching (often successful).
  • Syndactylization of the 5th and 4th toes.
  • Tenotomy.

Accessory Navicular

• Prevalence: Present in about 12% of the population.
• Symptoms: Often asymptomatic but associated with flatfoot.
• Natural History: Tends to fuse with growth.
• Treatment: If symptomatic, excision is effective, usually confirmed with a diagnostic injection first.

Habitual Toe Walking

• Cause: Often due to tight Achilles tendon.
• Natural History: Usually resolves spontaneously.
• Treatment: May require serial casting or Achilles lengthening if persistent.

Ball and Socket Ankle

• Description: A compensatory mechanism to increase ankle movement, often associated with other rigidity issues.
• Associations:
  • Tarsal coalition (50% of cases).
  • Absence of lateral rays (50%).
• Etiology: Generally congenital, sometimes part of conditions like fibula hemimelia.

Juvenile Bunions

• Gender Prevalence: Girls > Boys.
• Management: Avoid surgery where possible to prevent recurrence due to growth; accommodative shoe wear is recommended.
• Surgical Consideration: Ensure the first ray is not hypermobile if surgery is considered.

Iselin’s Disease

• Description: Traction apophysitis of the 5th metatarsal (MT) base.
• Management: Non-operative treatment.

Sever’s Disease

• Description: Traction apophysitis of the calcaneal apophysis.
• Age Range: Typically affects children aged 7-15 years.
• Management: Non-operative treatment.