II. Exam: Observation

  1. Gait evaluation with Foot Progression Angle
    1. See In-Toeing
    2. See Out-toeing
  2. Lateral view
    1. Normal neonatal foot dorsiflexed >90 degrees
    2. Rule-out fixed equinus (Clubfoot) position
      1. Tiptoe walking (foot plantar flexed)
      2. Tight heel cord
  3. Plantar view (footprint shape)
    1. Kidney bean (sole deviated medially)
      1. Metatarsus Adductus
    2. Banana (sole deviated laterally)
      1. Calcaneovalgus Deformity
  4. PA View (from behind, while in neutral position)
    1. Heel varus with inverted foot (medial malleoli apart)
      1. Metatarsus Adductus
    2. Heel valgus with everted foot (medial malleoli touch)
      1. Calcaneovalgus Deformity

III. Prevention: Shoe Recommendations for properly fitting shoe

  1. Adequate criteria met by inexpensive shoes
  2. Straight, no inward medial or lateral toe pressure
  3. Broad enough
    1. Toes assume natural, compressed standing position
  4. Reference
    1. Staheli(1980) Pediatrics 65:13-7

IV. Risk Factors: Foot deformity

  1. Intrauterine compression
    1. Multiple Gestation
    2. Uterine malformation/myoma
  2. Uterine compression
    1. Increased uterine muscle tone
    2. Oligohydramnios
    3. Fetal Macrosomia
    4. Non-vertex presentation (e.g. breach presentation)
  3. Extrauterine compression
    1. Small maternal Pelvis
    2. Prominent maternal LS spine
    3. Tight abdominal muscles
  4. Maternal Hypertension (unclear Mechanism)
  5. General fetal hypotonia
    1. Central or peripheral nervous system disease
    2. Congenital muscle disease
  6. Congenital muscle imbalance (Myelomeningocele)
  7. Family History
    1. Clubfoot
    2. Dislocated hip

V. Associated conditions: Foot Deformities

  1. Arthrogryposis
  2. Brain Tumor
  3. Cerebral Palsy
  4. Charcot-Marie-Tooth disease
  5. Congenital dislocation of hip
  6. Duchenne's Muscular Dystrophy
  7. Friedreich's ataxia
  8. Sacral agenesis
  9. Spina bifida
  10. Sacral Lipoma
  11. Spinal cord tumor

VI. References

  1. Churgay (1993) Am Fam Physician 47(4):883
  2. Hoppenfeld (1976) Exam. Spine Extremities, p.159-60,223

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