Pes calcaneovalgus Pes metatarsus adductus

University of Zagreb, School of Medicine Department of Orthopeadics Darko Antievi

Pes calcaneovalgus

Pes calcaneovalgus
Foot is dorsi-flexed, everted The dorsum readily touches the antero-lateral surface of the leg Plantar flexion ceases at around the mid-position The foot as whole is anatomically normal

Pes calcaneovalgus
The foot responds rapidly and favourably to gentle manipulation Streching towards plantar flexion and varus Resistance to primary correction should be a signal to review the diagnosis and search for neurological component

Pes calcaneovalgus

Pes calcaneovalgus
Rare posterior (benign) angulation of the tibia, Vertical talus Arthrogryposis multiplex Neurological condition

Pes calcaneovalgus
The mother should be instructed to strech the foot into equinus and varus, Prognosis is good, In few patients a flat foot with some fixed valgus of the heel may persist, Developmental dyplasia of the hip have to be ruled out.

Pes metatarsus adductus

Medial deviation of the FF with various degrees of supinaton and neutral or mild valgus of the hindfoot
Confusing terminology: metatarsus adductovarus; metatarsus varus; skewfoot.

Pes metatarsus adductus

Common condition in infants Rarely seen in older children Common cause of intoeing More obvious btw. 6-12 months or when child starts to walk

Pes metatarsus adductus

Differential Diagnosis
Club-foot (mild form) Serpentine foot (rare structural deformity) Rare forms of hallux varus

Metatarsus adductus - etiology intrauterine positioning or molding

Metatarsus adductus - etiology

Muscle imbalance (Kite, 1967.) Tibialis anterior insertion into plantar aspect of the medial cuneiform, Contracture of the capsular ligaments Combination of above
JBJS(B) 1979.

Metatarsus adductus evaluation:

Foorefoot deviated towards midline Hindfoot is normal or in mild valgus No vasting of the calf muscles Hallux varus

Evaluation

Bleck classification: the heel bisector method

Clinical picture

Metatarsus adductus treatment:

benign natural history; treatment rarely needed (1 in 10); spont. resolution in 86% pts. to age 4 y. serial casting only in severe type;

Rushforth GF. JBJS(B)1978 Ponseti & Baker, JBJS(A), 1966.

Metatarsus adductus treatment: surgery in older patient with symptoms; soft tissue surgery; double osteotomy of midfoot (open wedge medial cuneiform + closing wedge cuboid).

Metatarsus adductus indications: surgery in patient with symptoms older than 2 years; Poor shoe fitting; Severe forms
(Bleck classification)

Metatarsus adductus
14 years girl poor shoe-fitting + occasional pain

Abductor hallucis tendon release

Pre-operative

Post-operative

Naviculo-metatarsal angle

X-ray of medial soft tissue release by capsulotomy in severe type of metatarsus adductus

Skewfoot
Is rare deformity with components of malignment in forefoot, midfoot and hindfoot. Forefoot is on adduction, navicular is laterally subluxated and heel is in valgus. Etiology is unknown.

different structural relationship of foot bones

equinovarus foot

metatarsus adductus normal foot

skewfoot

vertical talus

metatarsus adductus: double osteotomy of midfoot

skewfoot Four years after op,: clinical & X-ray appearance of both foot after double osteotomy of the left foot.

skewfoot

Three months post-op. (right foot) - double osteotomy of the midfoot