Musculoskeletal Conditions:
Congenital
Acquired
Congenital: failure of the foot and ankle to develop in the usual way during pregnancy, so the abnormality exists when we are born
Either the “building blocks” (BONES) are wrong, or,
The SOFT TISSUES of the foot and ankle (muscles, tendons and ligaments) are altered in form or
function, so that the foot doesn’t take up its normal configuration
Congenital abnormalities – bones
Absent bones - rare (need to know how many bones)
Bones in an abnormal position (need to know their normal relationships)
Fused bones (need to know how many bone)
How many bones?
1- Absent bones
Foot Anatomy
Hind-foot = 2 Bones – Calcaneus and Talus
Mid-Foot = 5 Bones – Navicular, Cuboid and 3 Cuneiforms
Fore-foot = 5 Metatarsals, 2 phalanges 1st toe, 3 phalanges 2nd5th toes Foot
2- Bones in an abnormal position – VERTICAL TALUS
Vertical Talus
Rocker bottom foot
Associated with a wide variety of neuromuscular abnormalities
Rare
Relatively little functional abnormality
3-Fused bones
Tarsal Coalitions
1st described by Buffon in 1796
Rare – true incidence unknown because often asymptomatic
Usually Calcaneus fused to either Talus or Navicular
Often present with non-specific mid-foot or hind-foot symptoms
Usually don’t need surgery
Congenital abnormalities – soft tissues
Abnormal configuration of the foot
Talipes Equino - Varus
1:1,000 births
Affects both feet in 50%
Idiopathic: no identifiable cause, but genetics plays a part as there is often a strong family history. More common in boys.
Neuromuscular: specific problem with foot’s nerve or muscle control (e.g. spina bifida) causing foot deformity through imbalance
Syndromic: foot deformity related to more widespread joint, cardiac and pulmonary abnormalities – often genetic problem
Postural: late stages of pregnancy – foot squashed in abnormal position – feet improve spontaneously or with short course of physiotherapy – usually completely normal by about 3 months of age
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