Ankle and Foot Anatomy and Deformities

Flashcards covering ankle and foot anatomy, club foot (Congenital Talipes Equino Varus) pathology and treatment, as well as foot deformities like Pes cavus and Pes planus.

What bones form the ankle joint and what type of joint is it?

The ankle joint is formed by the meeting of the tibia and fibula of the lower leg with the talus of the foot. It is classified as a synovial hinge joint.

Which movements occur at the ankle joint versus the subtalar joint?

Dorsiflexion and plantarflexion occur at the ankle joint, whereas inversion and eversion occur at the subtalar joint.

What are the seven deformities of the foot listed in the lecture notes?

1. Congenital talipes equino varus
2. Pes cavus
3. Pes planus
4. Hallux valgus
5. Hammer toe
6. Claw toe
7. Mallet toe

What is the incidence, gender distribution, and bilaterality of Congenital Talipes Equino Varus (Club foot)?

Incidence ranges from $1.2 / 1000$ births. Boys are affected twice as often as girls, and the condition is bilateral in $\frac{1}{3}$ of cases.

What is the pathology and visual presentation of Congenital Talipes Equino Varus (Club foot)?

The skin and soft tissue of the calf and medial side of the foot are short and underdeveloped. The navicular and entire forefoot are shifted medially and rotated into supination (subluxation of the talonavicular joint).

What clinical position is the foot in at birth with Congenital Talipes Equino Varus?

The ankle is in plantarflexion, the heel is inverted, and the forefoot is adducted.

How are equinus, varus, and calcaneus defined?

Equinus = plantarflexion Varus = adduction Calcaneus = dorsiflexion

What is the term for talipes equino varus deformity that occurs after birth?

Acquired talipes equino varus.

How is X-ray used to diagnose club foot?

A line is drawn passing through the long axis of the talus. Normally it passes at or medial to the 1st metatarsal bone; in club foot, it passes lateral to it.

What is the sequence of correcting components in the conservative Ponseti Method for club foot?

The sequence is C-A-V-E: Cavus, Adductus, Varus, then finally Equinus.

How is each component of C-A-V-E manipulated during the Ponseti Method?

1. Cavus is corrected by supinating the forefoot.
2. Adductus and Varus are corrected by gradually abducting the midfoot while applying pressure against the head of the talus.
3. Equinus is corrected by dorsiflexing the foot (facilitated by a simple percutaneous tenotomy of the tendo Achilles).

What is the timeline and casting protocol for non-operative treatment of club foot?

Starting from the 1st day of life (every feed) for $2$ weeks. After that, an above-knee plaster cast with the knee flexed $90^\circ$ is worn for $3$ months, changed every week due to fast growth.

What brace is used during the maintenance phase of club foot treatment to prevent relapses?

A Foot Abduction Brace (Dennis Browne Boots) worn full-time for $2$ to $3$ months and thereafter at night for $3$ to $4$ years.

What operative surgical options exist if non-operative treatment of club foot fails?

1. Soft tissue release: lengthening of tendo Achilles, Tibialis posterior, FDL, and FHL by Z-plasty.
2. Tendon transfer: Ant tibialis tendon from medial to lateral side.
3. Arthrodesis & Calcaneal osteotomies: for children aged $4$ to $7$, shortening of lateral side by calcaneo-cuboid fusion (plaster for $1$ year post-op).

What conditions may be associated with club foot?

1. Neuromuscular disorder
2. Meningomyelocele
3. Cerebral palsy
4. Arthrogryposis

What are the key characteristics of Congenital Talipes Calcaneo-valgus?

It is the opposite of TEV; the foot is everted and dorsiflexed. It is less common and less severe than TEV and responds well to treatment.

What is Pes cavus, what are its causes, and what are its clinical features?

Pes cavus ("High arched foot") is a high longitudinal arch caused by muscle imbalance. Causes include congenital factors, neurological diseases (Friedreich ataxia, Charcot-Marie-Tooth disease), and poliomyelitis. Clinical features include painful callosities beneath metatarsal heads, clawed toes, and necessity to check spine for spina bifida.

What is Pes planus, what are its causes, and how is it managed?

Pes planus ("Flat foot") is a decrease in the longitudinal arch where the medial border contacts the ground. Commonest cause is congenital, alongside muscular weakness, paralysis, or trauma. Infants have flat feet for the 1st $2$ years of life. It is usually asymptomatic; treatment is usually not required, or medical shoes or talocalcaneal arthrodesis may be needed.