Principles and Management of Pediatric Foot and Ankle Deformities and Malformations : A Principles Based, Practical Guide to Their Assessment and Management.

Principles and Management of Pediatric Foot and Ankle Deformities and Malformations -- Table of Contents -- CHAPTER 1 Introduction -- PURPOSE OF THE BOOK -- HOW TO USE THE BOOK -- CHAPTER 2 Basic Principles -- BASIC PRINCIPLE #1: Techniques change, but principles are forever -- BASIC PRINCIPLE #2: A thorough knowledge of the normal anatomy of the child's foot is mandatory as the foundation for the assessment and management of foot deformities in children -- BASIC PRINCIPLE #3: The average normal foot shape in children is different than the average normal foot shape in adults -- BASIC PRINCIPLE #4: Age-related anatomic variations in the shape of the foot and the natural history of each one must be appreciated -- BASIC PRINCIPLE #5: "The foot is not a joint!" In all congenital and developmental deformities and most malformations of the child's foot, there are at least two segmental deformities that are often in rotationally opposite directions from each other, "as if the foot was wrung out" -- BASIC PRINCIPLE #6: One must understand subtalar joint positions and motions in a manner that supersedes the confusing and inconsistent terminology in the literature -- BASIC PRINCIPLE #7: A thorough and working knowledge of the biomechanics of the foot, and of the subtalar joint complex in particular, is mandatory for assessment and management of foot deformities in children -- BASIC PRINCIPLE #8: In the normal foot, the overall shape is determined by the shapes and interrelationships of the bones, coupled with the strength and flexibility of the ligaments. Muscles maintain balance, accommodate the foot to uneven terrain, protect the ligaments from unusual stresses, and propel the body forward -- BASIC PRINCIPLE #9: The default position of the subtalar joint is valgus everted.

BASIC PRINCIPLE #10: Valgus deformity of the hindfoot can be thought of as representing a continuum -- BASIC PRINCIPLE #11: Cavus means hollow, empty, or excavated and is manifest in the foot by plantar flexion of the forefoot on the hindfoot. The plantar flexion may be along the medial column of the foot or across the entire midfoot. The subtalar joint may be in varus, neutral, or valgus. The ankle joint may be in plantar flexion (equinus), neutral, or dorsiflexion calcaneus). And there may be a combination of these deformities -- BASIC PRINCIPLE #12: The foot deformity may be the primary problem or the result of the primary problem, i.e., a neuromuscular disorder. Differentiation is important -- BASIC PRINCIPLE #13: Be accurate with terminology -- BASIC PRINCIPLE #14: Do not focus entirely on the foot. There is an entire child above the foot -- CHAPTER 3 Assessment Principles -- Assessment Principle #1: A complete and detailed clinical and radiographic assessment of the child's foot is required before treatment is initiated -- Assessment Principle #2: Clinical evaluation of the child's foot begins with a clinical evaluation of the child -- Assessment Principle #3: Congenital and developmental deformities should be differentiated -- Assessment Principle #4: Static and progressive foot deformities should be differentiated, and the rate of progression established, if possible -- Assessment Principle #5: It is often more challenging to ascertain the history of pain and/or dysfunction that is related to a foot deformity in a child than in an adult, but it is worth the effort -- Assessment Principle #6: Assessment of pain must be specific-ask where, when, what level/severity, what associations -- Assessment Principle #7: Physical evaluation of the child's foot begins with a physical evaluation of the child.

Assessment Principle #8: Assessment of each of the segmental deformities of the foot and ankle is imperative before planning treatment, as a plan needs to be established to correct each one -- Assessment Principle #9: Each segment of the foot should be evaluated for shape/deformity, flexibility, and skin integrity. Documentation should be specific -- Assessment Principle #10: The accurate assessment of subtalar motion is an inexact science, but you can better at it by practicing -- Assessment Principle #11: An ankle joint deformity may coexist with a foot deformity, or it may be an isolated deformity. It must be differentiated -- Assessment Principle #12: The presence of a gastrocnemius or an tendo-Achilles contracture must be identified and differentiated from each other -- Assessment Principle #13: A detailed evaluation of strength, sensation, reflexes and vascularity is required -- Assessment Principle #14: The foot must be assessed clinically in weight-bearing not just on the examination table -- Assessment Principle #15: If pain is a complaint, the child should be asked to point to the exact location(s) -- Assessment Principle #16: Signs and symptoms must match the presumed pathology, so ensure that you have enough information before focusing on a radiographic finding -- Assessment Principle #17: All radiographs for the assessment of foot deformities should be obtained in weight-bearing, or simulated weight-bearing if the former is not possible because of extreme youth or the child's inability to stand -- Assessment Principle #18: The foot-CORA (center of rotation of angulation method should be used pre-, intra and postoperatively for the most objective evaluation of foot deformities and malformations.

Assessment Principle #19: Hindfoot flexibility in a cavovarus foot deformity should be assessed objectively with the radiographic equivalent of the modified Coleman block test -- Assessment Principle #20: There is usually a projectional artifact on the lateral radiograph of a foot with a varus/inverted or valgus/everted hindfoot deformity -- Assessment Principle #21: Do not forget about ankle radiographs -- Assessment Principle #22: A CT scan in all three orthogonal planes and with 3D reconstruction is the best imaging modality for more detailed assessment of complex foot deformities and malformations. It is the imaging modality of choice to assess tarsal coalitions -- Assessment Principle #23: An MRI is rarely helpful or indicated for assessment of foot deformities and malformations, except in special circumstances -- Assessment Principle #24: A bone scan is a good and relatively inexpensive way to identify a specific site(s) of inflammation pain, and is excellent at diagnosing complex regional pain syndrome -- CHAPTER 4 Management Principles -- MANAGEMENT PRINCIPLE #1: The decision (to operate) is more important than the incision (i.e., the surgical technique) -- MANAGEMENT PRINCIPLE #2: A less-than-ideal surgical or nonsurgical outcome can be due to a poor technique, a poor technician, or both -- MANAGEMENT PRINCIPLE #3: You cannot un-operate on anyone -- MANAGEMENT PRINCIPLE #4: The (surgical) treatment could be worse than the condition itself -- MANAGEMENT PRINCIPLE #5: Modalities that correct deformities: (1) natural history, (2) physical stretching, (3) serial casting, and (4) surgery -- MANAGEMENT PRINCIPLE #6: Modalities that correct dynamic deformities: (1) focal injection of tone-reducing medication into muscles and (2) muscle-balancing tendon surgery.

MANAGEMENT PRINCIPLE #7: Modalities that maintain deformity correction: (1) focal injection of tone-reducing medication into muscles, (2) special shoes/braces, (3) orthotics, (4) physical stretching, and (5) balanced muscles -- MANAGEMENT PRINCIPLE #8: Treatment (nonoperative and/or operative) is indicated for: Congenital deformities and malformations that are known, or expected, to cause pain and/or functional disability unless corrected, and (2) Developmental and acquired deformities and malformations that are creating pain and/or functional disability -- MANAGEMENT PRINCIPLE #9: Surgical treatment is indicated for: (1) Congenital deformities and malformations that do not, or cannot, correct with nonoperative treatment and are known to cause pain and/or functional disability unless corrected, (2) Progressive cavovarus foot deformities that are associated with pain and/or functional disability, and (3) Other developmental, persistent, and recurrent deformities that do not adequately respond to prolonged attempts at nonoperative treatment designed -- MANAGEMENT PRINCIPLE #10: Provide clear, accurate, and reasonable expectations to the patient and family of the shortand long-term outcomes of nonoperative and operative management -- MANAGEMENT PRINCIPLE #11: A surgical plan for each of the segmental deformities and muscle imbalances needs to be established before proceeding with surgery -- MANAGEMENT PRINCIPLE #12: Correct deformity at the site of the deformity. If that is not possible, use compensatory bone and soft tissue procedures -- MANAGEMENT PRINCIPLE #13: Preserve joint motion (particularly subtalar joint motion) in the feet of children and adolescents by utilizing soft tissue releases/plications and osteotomies instead of arthrodeses -- MANAGEMENT PRINCIPLE #14: Use biologic rather than technologic, interventions.

i.e., rearrange and/or reshape anatomic parts rather than replace or interfere with them.

The most complex fields are often the most challenging to teach; thankfully, Principles and Management of Pediatric Foot and Ankle Deformities and Malformations was written by the most renowned teacher in pediatric foot and ankle surgery, offering orthopedists, foot and ankle surgeons and podiatrists an invaluable and comprehensive guide to the assessment and treatment of children's feet. This text was designed to be practical, accessible, and immediately applicable-focusing on principles of treatment rather than reductive "cookbook" approaches that privilege piecemeal techniques over holistic understanding. Don't fall behind in the evolving field of child foot deformities and malformations. Stay current and informed through key principles of assessment and management, conveyed by an orthopedic surgeon with almost three decades of experience. Features: Tables, illustrations, and bullet points for added readability Special topic including rare iatrogenic and idiopathic deformities How-to guides to soft tissue and bony procedural techniques Intricate illustrations accompany surgical instruction Detailed descriptions of soft-tissue and bone procedures, with treatment recommendations.

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Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2024. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.