Causes
Idiopathic
- Clubfoot seqüela
Trauma
NM
- CNS
- CP
- Spinal cord
- Spin bifida
- PNS
- HSMN
- Muscular
- Dystrophy
- CNS
B/L: CMT (most common)
T ant, Per brevis and intrinsic weakness
Unilateral: Spinal cord tumor until proven otherwise
CMT
- AD, Cr 17
- PMP 22 protein is affected
- Recessive forms appear earlier and more severe
HSMN
| Column 1 | Column 2 | Column 3 | Column 4 |
|---|---|---|---|
| CMT 1 | CMT 2 | Dejerine stotta | |
| Inheritance | AD | AD | AR |
| Age | 10-20 | 20-30 | Infant |
| Pathology | Demylination | Wallerian degn | |
| Reflex | Absent | Present | |
| NC/EMG | Inc Latency; dec velocity | EMG normal | |
| Severity | Less | Less | severe |
Deformity: Mobile hind foot
- Cavus
- Plantar flexed 1st ray: Per Longus overpowers T ant
- Varus
- Plantar flexed 1st ray pronates the foot
- This is compensated by varus due to tripod effect
- Equinus
- Weak Tant overpowered by GS
- Claw toes
- Intrinsic minus
- recruitment of EHL and EDL due to weak T ant
History
- Stiffness
- Deformity
- Recc sprains
- Painful callosities due to clawing
Examination
- Stand and look
- Deformity
- stock legs
- Hand wasting
- Coleman block test: to know the mobility of ST joint
- Walk and look gait: broad based ataxic
- Sit and look
- Callosities
- Clawing
Feel
- Sensation
- Pulse
- Tenderness
Move
- Is clawing flexible
Spl tests
- Silverskeiold test
- Muscle power:T Post, T Ant, P Long, P Brevis
- Spine
- Reflex
Investigation
- X Ray wt bearing
- increased pitch angle and meary angle
- MRI
- EMG
- NCS
Management
- Less symptomatic foot can be managed non surgically by accommodating foot wear, physiotherapy and stretching, but does not alter the course
- Treatment for more symptomatic foot is surgical and the aim is plantigrade painless stable and mobile foot
- Surgery has to be tailored to the underlying cause, deformity, patients symptoms and risk of progression due to muscle imbalance. Correction of deformity with out addressing the imbalance will not be successful
Surgery
- Plantar flex 1st ray:
- Dorsal closing wedge osteotomy
- P long to braves transfer
- Cavus
- Plantar fascia release
- Varus
- Lateral closing wedge osteotomy calcaneus
- Equinous
- TA lengthen
Hind foot fixed
- Triple arthrodesis
Clawing
- Girdlestone FDL to EDL transfer
- Weil osteotomy
- PIP fusion and weil
- MTPJ release and PIPJ excision
- Big toe
- Johns procedure: MTPJ arthrodesis and EHL to 1st MT