Foot Disorders

Paediatric Foot Disorders

B Milne B Milne FRACS (Orth)FRACS (Orth)

Paediatric Orthopaedic FellowPaediatric Orthopaedic Fellow

Foot Disorders

Anatomy

Foot Disorders

Bones of the foot

Foot Disorders

Valgus

Deviation of the distal body part away from the midline

Foot Disorders

Varus

Deviation of the distal body part towards the midline

Foot Disorders

Adduction

Movement of forefoot towards the midline

Foot Disorders

Abduction

Movement of forefoot away from the midline

Foot Disorders

Inversion

deviation of foot medially at the subtalar joint

Foot Disorders

Eversion

deviation of foot laterally at the subtalar joint

Foot Disorders

Plantarflexion

deviation of foot downwards at the ankle joint

Foot Disorders

Dorsiflexion

deviation of foot upwards at the ankle joint

Foot Disorders

Pronation

Combined dorsiflexion, eversion and abduction

Foot Disorders

Supination

Combined plantarflexion, inversion and adduction

Foot Disorders

Cavus

elevated longitudinal arch of the foot

Foot Disorders

Planus

flattened longitudinal arch of the foot

Foot Disorders

Calcaneus

extreme dorsiflexion deformity of the hindfoot

Foot Disorders

Equinus

extreme plantarflexion deformity of the hindfoot

Foot Disorders

Congenital Talipes Equinovarus

Also known as Clubfoot Also known as Clubfoot

Characterised by deformity CAVECharacterised by deformity CAVE

–– Cavus of the midfoot archCavus of the midfoot arch

–– Adduction of the forefootAdduction of the forefoot

–– Varus of the hindfootVarus of the hindfoot

–– Equinus of the hindfootEquinus of the hindfoot

Foot Disorders

CTEV

Foot Disorders

Incidence

UsualUsual 1 per 1,000 1 per 1,000

M:F M:F 2.5 : 12.5 : 1

Bilateral Bilateral 50%50%

MaorisMaoris 7 per 1,0007 per 1,000

RiskRisk 22--5% in siblings5% in siblings

25% if both parent 25% if both parent

and sibling affectedand sibling affected

Foot Disorders

NeurologicalNeurological

–– MyelomeningoceleMyelomeningocele

–– Spina bifida occultaSpina bifida occulta

Arthrogryposis Congenita MultiplexArthrogryposis Congenita Multiplex

Chromosome AbnormalitiesChromosome Abnormalities

–– Trisomy 13 & 18Trisomy 13 & 18

Associated conditions

Foot Disorders

Aetiology UnknownUnknown

TheoriesTheories

–– Packaging defect (Packaging defect (HippocratesHippocrates) )

–– Neuromuscular defect Neuromuscular defect

–– Reduced anterior horn cells (Reduced anterior horn cells (SwartSwart))

–– Increase in type I (slow) fibresIncrease in type I (slow) fibres

–– Arrest of foetal developmentArrest of foetal development

–– Primary germ plasm defect of talusPrimary germ plasm defect of talus

–– Retracting fibrosisRetracting fibrosis

Foot Disorders

Diagnosis

Prenatal Prenatal

UltrasoundUltrasound

Structural Structural

PosturalPostural

Foot Disorders

Treatment

Foot Disorders

Ponseti

Serial casting to Serial casting to

correct deformitycorrect deformity

Often requires Often requires

achilles tendon achilles tendon

tenotomy to tenotomy to

correct equinuscorrect equinus

Foot Disorders

Ponseti - Boots and Bars

Foot Disorders

Relapse

Foot Disorders

Surgery

Staged surgeryStaged surgery

Posteromedial Posteromedial

releaserelease

Posterolateral Posterolateral

releaserelease

Foot Disorders

Relapse

Foot Disorders

Congenital Talipes

Calcaneovalgus

Foot Disorders

CALCANEOVALGUS

FOOT 1:1000 live births1:1000 live births

Intrauterine PositioningIntrauterine Positioning

Associated with lateral tibial torsionAssociated with lateral tibial torsion

Common in first bornCommon in first born

Dorsiflexion/eversion/abductionDorsiflexion/eversion/abduction

Passively correctablePassively correctable

Resolves spontaneously Resolves spontaneously -- passive stretches & passive stretches &

splints may be usedsplints may be used

Foot Disorders

METATARSUS

ADDUCTUS

Foot Disorders

METATARSUS

ADDUCTUS

1:1000 incidence1:1000 incidence

50% bilateral50% bilateral

Results from intrauterine positionResults from intrauterine position

Forefoot adducted at TMT joint, Forefoot adducted at TMT joint,

sole is kidney shaped, heel is NOT sole is kidney shaped, heel is NOT

equinusequinus

Foot Disorders

METATARSUS

ADDUCTUS

86% resolve spontaneously by age 86% resolve spontaneously by age

6, 95% by age 16.6, 95% by age 16.

1010--15% also have DDH15% also have DDH

Medial skin crease suggestive of Medial skin crease suggestive of

resistant caseresistant case

Foot Disorders

Metatarsus Adductus

Grading System Grade IGrade I

–– OvercorrectsOvercorrects

Grade IIGrade II

–– Corrects to neutralCorrects to neutral

Grade IIIGrade III

–– Does not correct to neutralDoes not correct to neutral

Foot Disorders

Metatarsus Adductus

Treatment

CorrectableCorrectable

–– No treatmentNo treatment

Not correctableNot correctable

–– Serial castingSerial casting

–– ?straight medial border shoes?straight medial border shoes

Not correctable and symptomaticNot correctable and symptomatic

–– ? Surgery? Surgery

Foot Disorders

Metatarsus Adductus

Long term results of patients with Long term results of patients with

mildmild--moderate residual deformity moderate residual deformity

after treatment are good.after treatment are good.

SURGERY indicated in children SURGERY indicated in children

>5yo with severe symptomatic >5yo with severe symptomatic

residual metatarsus adductus. residual metatarsus adductus.

Foot Disorders

Surgical treatment

Metatarsus Adductus

Adductor Adductor

Hallucis releaseHallucis release

Medial opening Medial opening

cuneiform and cuneiform and

lateral closing lateral closing

cuboid cuboid

osteotomiesosteotomies

Foot Disorders

Skewfoot

Combination of Combination of

forefoot forefoot

deformity of deformity of

metatarsus metatarsus

adductus and adductus and

hindfoot hindfoot

deformity of deformity of

valgus flatfootvalgus flatfoot

Foot Disorders

Skewfoot

RareRare

Aetiology unknown Aetiology unknown

–– ? iatrogenic? iatrogenic

–– ? muscle imbalance? muscle imbalance

–– often syndromaloften syndromal

Natural history unknown ? Natural history unknown ?

–– Little evidence of disabilityLittle evidence of disability

Foot Disorders

Skewfoot

Symptoms: Pain over talar head, 1st MT Symptoms: Pain over talar head, 1st MT

head, 5th MT basehead, 5th MT base

Treatment in young children:Treatment in young children:

Serial casts as for metatarsus adductus Serial casts as for metatarsus adductus

with varus stress on heelwith varus stress on heel

Aim to convert foot to flatfootAim to convert foot to flatfoot

Treatment in older children: osteotomies Treatment in older children: osteotomies

of the calcaneus and midfootof the calcaneus and midfoot

Foot Disorders

Pes Cavus

Foot Disorders

PES CAVUS

Elevated longitudinal arch due to Elevated longitudinal arch due to

plantar flexion of the forefoot &/or plantar flexion of the forefoot &/or

dorsiflexion of the calcaneus.dorsiflexion of the calcaneus.

Secondary contracture of plantar Secondary contracture of plantar

fascia.fascia.

Claw toes Claw toes -- often the first deformity often the first deformity

seen.seen.

Foot Disorders

Cavus Foot - Aetiology

> 50% > 50% NeuromuscularNeuromuscular

Hereditary Motor Sensory Neuropathy (CMT)Hereditary Motor Sensory Neuropathy (CMT)

PoliomyelitisPoliomyelitis

Friedreich’s ataxiaFriedreich’s ataxia

Cerebral PalsyCerebral Palsy

Spina bifidaSpina bifida

Spinal cord tumourSpinal cord tumour

SyringomyeliaSyringomyelia

Foot Disorders

Cavus Foot - Aetiology

Non neurological causes include:Non neurological causes include:

–– IdiopathicIdiopathic

–– CTEV, ArthrogryposisCTEV, Arthrogryposis

–– TraumaticTraumatic

Compartment SyndromeCompartment Syndrome

Foot Disorders

Cavovarus

Plantarflexion of first rayPlantarflexion of first ray

Pronation of forefootPronation of forefoot

Adduction of forefootAdduction of forefoot

Hindfoot varusHindfoot varus

Toes clawedToes clawed

Foot Disorders

Cavus foot symptoms

Clawtoes Clawtoes -- calluses with shoescalluses with shoes

MetatarsalgiaMetatarsalgia

High archHigh arch

Anterior ankle painAnterior ankle pain

Recurrent ankle sprainsRecurrent ankle sprains

Foot Disorders

Cavus Treatment

Full neurologic workFull neurologic work--up especially if up especially if

unilateralunilateral

–– Spinal XSpinal X--Rays Rays

–– MRIMRI

–– NCSNCS

Referral to neurologistReferral to neurologist

Foot Disorders

Cavovarus foot - treatment

NonNon--operative operative orthotics orthotics

Surgery : Plantar release, dorsal Surgery : Plantar release, dorsal

cuneiform osteotomycuneiform osteotomy

–– Tendon tranfersTendon tranfers

–– Calcaneal osteotomyCalcaneal osteotomy

–– Ilizarov for multiply operated caseIlizarov for multiply operated case

Foot Disorders

CONGENITAL VERTICAL

TALUS

Foot Disorders

Congenital Vertical Talus

Irreducible dorsal dislocation of Irreducible dorsal dislocation of

navicular on talus with a fixed navicular on talus with a fixed

talocalcaneal complex. Dislocation talocalcaneal complex. Dislocation

can be limited to talonavicular joint can be limited to talonavicular joint

or can also involve calcaneocuboid or can also involve calcaneocuboid

joint.joint.

Common cause of rigid flatfootCommon cause of rigid flatfoot

50% bilateral50% bilateral

Foot Disorders

Congenital Vertical Talus

Teratologic Teratologic -- most CVTmost CVT

–– Chromosomal abnormalitiesChromosomal abnormalities

–– ArthrogryposisArthrogryposis

–– MyelomeningocoeleMyelomeningocoele

NeurogenicNeurogenic

Iatrogenic Iatrogenic -- overcorrection CTEVovercorrection CTEV

Idiopathic Idiopathic -- rarerare

Foot Disorders

NORMAL OBLIQUE TALUS VERTICAL TALUS

Foot Disorders

CVT TREATMENT

NonNon--operative initiallyoperative initially

–– stretchingstretching

–– serial castingserial casting

Foot Disorders

CVT - SURGERY

Surgery is aimed at correcting Surgery is aimed at correcting

hindfoot equinus and forefoot hindfoot equinus and forefoot

dorsiflexion and abductiondorsiflexion and abduction

Correction of hindfoot is the Correction of hindfoot is the

primary step in correction of the primary step in correction of the

footfoot

Foot Disorders

OBLIQUE TALUS

Talonavicular subluxation that reduces Talonavicular subluxation that reduces

with plantar flexion of the foot.with plantar flexion of the foot.

Treatment Treatment

–– ObservationObservation

–– OrthoticsOrthotics

–– Sugery: Pinning reduced talonavicular Sugery: Pinning reduced talonavicular

joint & tendoachilles lengtheningjoint & tendoachilles lengthening

Foot Disorders

TARSAL COALITION

Disorder of mesenchymal segmentation Disorder of mesenchymal segmentation

leading to fusion of 2 or more tarsal leading to fusion of 2 or more tarsal

bonesbones

Autosomal dominant with variable Autosomal dominant with variable

penetrancepenetrance

3% of population3% of population

50% bilateral50% bilateral

90% calcaneonavicular or talocalcaneal90% calcaneonavicular or talocalcaneal

Foot Disorders

TARSAL COALITION

May be bony, cartilaginous or fibrousMay be bony, cartilaginous or fibrous

Multiple coalitions may exist in same Multiple coalitions may exist in same

footfoot

Leading cause of peroneal spastic Leading cause of peroneal spastic

flatfootflatfoot

Foot Disorders

TARSAL COALITION

Become symptomatic when coalition Become symptomatic when coalition

ossifies:ossifies:

Hindfoot pain aggravated by activity. Hindfoot pain aggravated by activity.

Ankle sprainsAnkle sprains

Stiff subtalar jointStiff subtalar joint

Medial or lateral tendernessMedial or lateral tenderness

Peroneal spastic flatfootPeroneal spastic flatfoot

TALONAVICULAR 3-5yo

CALCANEONAVICULAR 8-12yo

TALOCALCANEAL 12-16yo

Foot Disorders

Normal oblique foot xray

Foot Disorders

CALCANEO-

NAVICULAR

BAR

ANTEATER’S

NOSE

Foot Disorders

TALONAVICULAR

COALITION

Foot Disorders

TARSAL COALITION

Asymptomatic Asymptomatic -- observationobservation

Symptomatic: NONSymptomatic: NON--OPERATIVE OPERATIVE

–– activity modificationactivity modification

–– OrthoticsOrthotics

–– Short leg walking castShort leg walking cast

Foot Disorders

TARSAL COALITION

OPERATIVE TREATMENTOPERATIVE TREATMENT

–– Calcaneonavicular Calcaneonavicular -- excision & EDB interpositionexcision & EDB interposition

–– TalocalcanealTalocalcaneal

adolescent with <50% of facet involved adolescent with <50% of facet involved -- resectionresection

subtalar OA or > 50% of facet involved subtalar OA or > 50% of facet involved -- subtalar fusion subtalar fusion

midfoot OA midfoot OA -- triple arthrodesistriple arthrodesis

Foot Disorders

Juvenile Hallux Valgus

Bunion

Foot Disorders

JUVENILE BUNION

Bilateral, familial, more common in Bilateral, familial, more common in

femalesfemales

Aetiology: Imbalance of forcesAetiology: Imbalance of forces

Predisposing factors:Predisposing factors:

Metatarsus primus varusMetatarsus primus varus

Long 1st MTLong 1st MT

Ligamentous laxityLigamentous laxity

Neurologic disordersNeurologic disorders

Shoewear with narrow toe boxShoewear with narrow toe box

Foot Disorders

JUVENILE BUNION Most asymptomatic & require no Most asymptomatic & require no

treatmenttreatment

NonNon--operative treatment: wide shoes operative treatment: wide shoes

and arch supportand arch support

Surgical treatment Surgical treatment -- progression of progression of

deformity or failed nondeformity or failed non--op txop tx

SOFT TISSUE CORRECTION

OSTEOTOMY - metatarsal

- phalangeal

- cuneiform

ARTHRODESIS

Foot Disorders

JUVENILE BUNION

ComplicationsComplications

* OVERCORRECTION/HALLUX VARUS

* RECURRENCE 20% (soft tissue only >50%)

- inversely related to age

REOPERATE AFTER SKELETAL MAT

* PHYSEAL INJURY - rare

* AVN - rare

* STIFFNESS

* DEFUNCTIONING 1ST RAY

Foot Disorders

BUNIONETTE Lateral prominence Lateral prominence

of 5th MT headof 5th MT head

Usually unilateralUsually unilateral

Irritated by shoewearIrritated by shoewear

Treatment:Treatment:

–– NonNon--operativeoperative

shoewear modificationshoewear modification

–– OperativeOperative

ExostectomyExostectomy

osteotomyosteotomy

Foot Disorders

Flexible Flatfoot

Flattening of the Flattening of the

medial longitudinal medial longitudinal

arch on standingarch on standing

Heel valgus, forefoot Heel valgus, forefoot

pronation and pronation and

abduction.abduction.

Prominent talar head Prominent talar head

medially.medially.

7%7%--22% prevalence22% prevalence

Bilateral and familialBilateral and familial

Associated with Associated with

ligamentous laxity ligamentous laxity

and limb alignment and limb alignment

problemsproblems

Foot Disorders

Flexible Flatfoot

Symptoms: midfoot ache, pretibial pain, Symptoms: midfoot ache, pretibial pain,

excessive shoe wear. Pain and callosity excessive shoe wear. Pain and callosity

over talar head.over talar head.

Longitudinal arch develops spontaneously Longitudinal arch develops spontaneously

during first decade and most flatfooted during first decade and most flatfooted

adults are asymptomatic.adults are asymptomatic.

Foot Disorders

Flexible Flatfoot

No treatment if asymptomaticNo treatment if asymptomatic

If symptomatic If symptomatic

–– Arch orthosis/UCBL insertsArch orthosis/UCBL inserts

–– Achilles tendon stretches if tightAchilles tendon stretches if tight

If refractory If refractory

–– wedge or sliding calcaneal osteotomy wedge or sliding calcaneal osteotomy

–– +/+/-- Achilles tendon lengtheningAchilles tendon lengthening

Foot Disorders

KOHLER’S DISEASE

Foot Disorders

KOHLER’S DISEASE

AVN of navicular due to repetitive AVN of navicular due to repetitive compressive forcescompressive forces

Males (5:1) Males (5:1)

4 4 -- 5 yo5 yo

Bilateral in 1/3Bilateral in 1/3

Self limitingSelf limiting

XX--Ray Ray -- flattening, sclerosis, flattening, sclerosis, irregularity of navicularirregularity of navicular

Foot Disorders

KOHLER’S DISEASE

May be asymptomaticMay be asymptomatic

Present with pain over navicular, Present with pain over navicular, antalgic gait, weight bearing on antalgic gait, weight bearing on lateral aspect of footlateral aspect of foot

Treat with decreased activity, Treat with decreased activity, orthotics with arch support +/orthotics with arch support +/--immobilisationimmobilisation

Prognosis excellentPrognosis excellent

Foot Disorders

FREIBERG’S INFRACTION

AVN usually of 2nd MT head (other MTs AVN usually of 2nd MT head (other MTs may be affected) due to vascular may be affected) due to vascular insufficiency 2insufficiency 200 to chronic stress to chronic stress

AdolescentsAdolescents

Female 75%Female 75%

Occasionally Occasionally

bilateralbilateral

XX--Ray: MT head flat & Ray: MT head flat & irregularirregular

Foot Disorders

FREIBERG’S INFRACTION

Metatarsalgia, mild swelling and Metatarsalgia, mild swelling and stiffnessstiffness

Treatment: Treatment:

–– nonnon--operativeoperative Walking castWalking cast

Metatarsal padMetatarsal pad

–– OperativeOperative curettage & bone graftcurettage & bone graft

Shortening MT osteotomyShortening MT osteotomy

extension osteotomyextension osteotomy

Foot Disorders

SEVER’S DISEASE

Traction apophysitis at insertion of Traction apophysitis at insertion of

Achilles tendonAchilles tendon

Heel pain & tenderness, aggravated by Heel pain & tenderness, aggravated by

activity & relieved by restactivity & relieved by rest

Decreased ankle dorsiflexionDecreased ankle dorsiflexion

Normal XNormal X--Rays Rays -- sclerosis and sclerosis and

fragmentation of calcaneal apophysis fragmentation of calcaneal apophysis

normal variantnormal variant

Treatment: Activity modification, rest, Treatment: Activity modification, rest,

heel cushion, stretches, NSAIDS, castheel cushion, stretches, NSAIDS, cast

Foot Disorders

SEVER’S DISEASE OR

NORMAL ?

Foot Disorders

ACCESSORY NAVICULAR

Normal variant seen in 4Normal variant seen in 4--21%21%

Often incidental discovery Often incidental discovery

Associated with flatfeetAssociated with flatfeet

Medial arch pain with overuse Medial arch pain with overuse

centred over navicular.centred over navicular.

External oblique XExternal oblique X--Ray view Ray view

demonstratesdemonstrates

Foot Disorders

Foot Disorders

ACCESSORY NAVICULAR

Treated with restriction of activities Treated with restriction of activities

+/+/-- immobilisation in short leg cast, immobilisation in short leg cast,

then shoe modification/padding then shoe modification/padding

Excision relieves pain but does not Excision relieves pain but does not

correct flatfootcorrect flatfoot

Foot Disorders

CURLY TOE

“Underlapping toe”. “Underlapping toe”. Flexion deformity of Flexion deformity of PIP jt with external PIP jt with external rotation and varus of rotation and varus of the toe.the toe.

Usually occurs in Usually occurs in lateral 3 toeslateral 3 toes

Familial, bilateral, Familial, bilateral, symmetrical, rarely symmetrical, rarely symptomaticsymptomatic

Due to muscle Due to muscle imbalanceimbalance

Foot Disorders

CURLY TOE

25% resolve spontaneously. 25% resolve spontaneously. Remainder don’t worsen with Remainder don’t worsen with growth but may develop symptoms growth but may develop symptoms and become stiff.and become stiff.

Treatment if symptomatic or if Treatment if symptomatic or if severe severe -- flexor tenotomyflexor tenotomy (FDL +/(FDL +/--FDB)FDB)

Late treatment Late treatment -- resection or resection or arthrodesis of PIP joint may be arthrodesis of PIP joint may be necessary for correctionnecessary for correction

Foot Disorders

OVERLAPPING

FIFTH TOE

Familial, bilateral & Familial, bilateral &

asymptomatic asymptomatic

Fifth toe adducted, extended & externally Fifth toe adducted, extended & externally rotated at MTP jt & overlaps fourth toerotated at MTP jt & overlaps fourth toe

May cause footwear problemsMay cause footwear problems

NonNon--operative tx: stretching & buddy tapingoperative tx: stretching & buddy taping

Operative Operative -- tenotomy, dorsal capsulotomy & tenotomy, dorsal capsulotomy & VV--Y advancementY advancement

Foot Disorders

OLIGODACTYLY

Congenital absence of toe(s)Congenital absence of toe(s)

Requires no treatmentRequires no treatment

Associated with fibular hemimelia Associated with fibular hemimelia

and tarsal coalitionand tarsal coalition

Foot Disorders

TOE POLYDACTYLY

Extra digits Extra digits -- preaxial, central or preaxial, central or

postaxialpostaxial

Incidence 2:1000Incidence 2:1000

Usually involves lateral ray (80%)Usually involves lateral ray (80%)

May be inherited (30%) (AD)May be inherited (30%) (AD)

25% bilateral25% bilateral

Associated with finger polydactyly & Associated with finger polydactyly &

metatarsal anomaliesmetatarsal anomalies

Foot Disorders

TOE POLYDACTYLY

Rudimentary digits treated by ligation in Rudimentary digits treated by ligation in

nursery and allowing “autoamputation”nursery and allowing “autoamputation”

Surgical excision of digit at 9Surgical excision of digit at 9--12 months 12 months

before starts wearing shoesbefore starts wearing shoes

Foot Disorders

TOE SYNDACTYLY

Fusion of adjacent toes (2ndFusion of adjacent toes (2nd--3rd)3rd)

Familial & asymptomaticFamilial & asymptomatic

Simple or ComplexSimple or Complex

Complete or partialComplete or partial

Simple does not require treatmentSimple does not require treatment

Complex separated at 18mths Complex separated at 18mths -- 5yrs.5yrs.

Foot Disorders

HAMMER

CLAW

MALLET

Foot Disorders

HAMMER TOE

Flexion deformity at PIP jt with hyperextension at DIP Flexion deformity at PIP jt with hyperextension at DIP

jt +/jt +/-- secondary hyperextension at MTP jt.secondary hyperextension at MTP jt.

Due to flexor tightnessDue to flexor tightness

Bilateral, symmetrical, commonly 2nd toe.Bilateral, symmetrical, commonly 2nd toe.

Asymptomatic early Asymptomatic early -- later painful corn, stiffnesslater painful corn, stiffness

Treatment flexor tenotomy in early childhood Treatment flexor tenotomy in early childhood

Fixed deformity Fixed deformity -- arthrodesis PIPJ + MTPJ dorsal arthrodesis PIPJ + MTPJ dorsal

capsular releasecapsular release

Foot Disorders

CLAW TOE

Flexion deformity at PIP and DIP jts with Flexion deformity at PIP and DIP jts with

hyperextension at MTP jthyperextension at MTP jt

Usually all 4 lesser toes involvedUsually all 4 lesser toes involved

Usually assoc with pes cavus but can be Usually assoc with pes cavus but can be

idiopathicidiopathic

Result of imbalance between intrinsics and Result of imbalance between intrinsics and

extrinsics musclesextrinsics muscles

Often asymptomatic.Often asymptomatic.

Symptoms Symptoms -- metatarsalgia, painful corns over metatarsalgia, painful corns over

PIP jtsPIP jts

Foot Disorders

CLAW TOE

Treatment:Treatment:

–– NonNon--operativeoperative

shoewear modification (deep toe box, soft shoes)shoewear modification (deep toe box, soft shoes)

Orthotics Orthotics -- metatarsal barmetatarsal bar

–– Operative Operative --

Capsule releaseCapsule release

TenotomyTenotomy

Tendon transferTendon transfer

Arthrodesis PIPJArthrodesis PIPJ

Foot Disorders

MALLET TOE

Flexion deformity at DIP jtFlexion deformity at DIP jt

Aetiology: FDL shorteningAetiology: FDL shortening

Commonly 2nd toeCommonly 2nd toe

Assoc with long 2nd MTAssoc with long 2nd MT

Symptoms from dorsal corn or toenail irritationSymptoms from dorsal corn or toenail irritation

Treatment: Treatment:

–– young child young child -- FDL tenotomy FDL tenotomy

–– fixed deformity fixed deformity -- excision arthroplasty or arthrodesisexcision arthroplasty or arthrodesis

Foot Disorders

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