Lower limb deformities.pptx

lower limb congenital deformities

1. Lower limb deformities

2. Coxa vara Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees .

3. Features shortening of limb limp. bilateral involvement….waddling gait Restricted abduction and internal rotation Causes Congenital Pathological. metabolic bone diseases (e.g. Paget's disease of bone), post- Perthes deformity, osteomyelitis, Traumatic

4. Diagnosis X Ray HE angle

5. Treatment HE angle of 45–60 degrees: observation and periodic follow up Indication for surgery HE angle more than 60 degrees, progressive deformity, neckshaft angle <90 degrees, development of Trendelenburg gait

6. Surgery subtrochanteric valgus osteotomy with adequate internal rotation of distal fragment to correct anteversion Complications Recurrence

7. Coxa valga Coxa valga describes a deformity of the hip where there is an increased angle between the femoral neck and femoral shaft. Coxa valga is often associated with shallow acetabular angles and femoral head subluxation.

8. Etiology bilateral neuromuscular disorders, e.g. cerebral palsy often have concurrent femoral anteversion skeletal dysplasias , e.g. Turner syndrome, mucopolysaccharidoses unilateral trauma causing growth plate arrest

9. Diagnosis X ray Treatment Coxa valga can be treated with varus derotation osteotomy (VDRO) and angled blade-plate fixation

10. Femoral Retroversion Common in early infancy Unilateral, R side > L side More common in obese children apparent when the pre-walking child stands with his or her feet turned out to nearly 90 degrees ("Charlie Chaplin appearance") It may gradually improve on its own during the first year of walking

11. Hallux valgus Hallux valgus is deviation of the big toe away from the midline, i.e. towards the lesser toes, and is usually associated with a bunion. affects women more than men Often bilateral Inherited fully enclosed shoes accelerate the development

12. Complications 2 nd MTP overloading and dislocations Treatment options. Non-operative. Wider toe box and pressure relief . Operative. Mild deformities. distal osteotomy (e.g. chevron)

13. Moderate deformities. Scarf or Ludloff , or a basal (proximal chevron or crescentic ) osteotomy . Severe deformities. Osteotomies or fusion of 1 st TM or MTP Joints

14. Complications of surgery. Infection Cutaneous nerve damage Recurrence or overcorrection of deformity Stiffness and overload of the second MTP joint. Arthritis

15. Hallux rigidus Hallux rigidus is a painful condition of the hallux MTP joint characterised by loss of motion especially in dorsiflexion. osteophyte formation on the dorsum and sides of the joint.

16. trauma or repetitive microtrauma (sport ) strong family history Patients complain of stiffness and pain on weight bearing.

17. Non-operative treatment . Provision of a stiff-soled shoe with a deep toe box or a rocker-soled shoe. Surgical management. injection/manipulation , cheilectomy (a radical debridement and excision of the part of the joint blocking movement) fusion Arthroplasty ( Keller’s-type procedure or silicon interposition )

18. Congenital talipes equinovarus (CTEV) (the ‘club foot’) Multiplanar deformity: hindfoot equinus and varus , midfoot adductus and forefoot cavus Incidence is 1–6 per 1000 live births, more common in boys and with a familial tendency Most cases are idiopathic but neuromuscular causes include spina bifida and arthrogryposis Scoring systems ( Pirani / Dimeglio ), are used to assess the severity

19. The diagnosis of CTEV may be made during an antenatal ultrasound.

20. Pathology

21. Types Postural Idiopathic Neuromuscular i.e Spina bifida; arthrogryposis ; Syndromic Trisomy 15

22. Treatment PONSETI METHOD corrects foot deformity in 95 % of idiopathic cases without the need for a formal surgical release. Manual repositioning Series of well moulded above-knee plaster casts.

23. Foot abduction orthosis (FAO) Percutaneous Achilles tenotomy Recurrent deformity can be treated with further plasters,but a tibialis anterior tendon transfer may be required around the age of 2.5–4

24. Feet treated with the Ponseti method are less stiff, less likely to be painful and less subject to overcorrection than those treated surgically.

25. SURGICAL TREATMENT When conservative treatment fails, surgical intervention is required , ideally before walking age . sequential release of the pathologically tight structures via either a Turco incision or the Cincinnati incision.

26. Stiffness and over or undercorrection are common complications

27. Talipes calcaneovalgus (TCV) Calcaneovalgus Foot is a common acquired condition caused by intrauterine "packaging" seen in neonates that presents as a benign soft tissue contracture deformity of the foot characterized by hindfoot eversion and dorsiflexion.

28. Diagnosis is made clinically Treatment is usually observation with passive stretching and possible casting as the condition resolves spontaneously in 3-6 months.