EC Paediatrics

Foot deformities should be carefully examined as an essential part of the child's evaluation. A thorough examination should include vascular, dermatologic, and neurologic evaluation of the lower extremities, as well as inspection, palpation, and assessment of the range of motion of the joints in both feet. Common foot abnormalities include adductor hallux valgus, clubfoot, valgus flatfoot (flexible flatfoot), postural flatfoot (rigid flatfoot), adductus varus, and many others. Most treatments include conservative measures and surgery. However, if these conditions do not improve or become worse, it is important to seek medical attention. Cases requiring surgical correction should be referred to a specialist with expertise in the correction of foot and leg deformities in children. Treatment should be initiated early, even at birth, for clubfoot according to Ponseti, or clubfoot with fibula graft according to Hung NN. Until recently, children with this deformity could be diagnosed in utero and planning could be done from birth. Currently, the conditions for treating congenital deformities allow for treatment while the child is still in the womb, as with other deformities. With some exceptions, surgical techniques are recommended if conservative correction of the foot within 3 to 6 months is not completely satisfactory. Cases requiring surgical correction should be referred to a specialist with expertise in the correction of foot and leg deformities in children.

 Keywords: Clubfoot; Flatfoot; Adductus Varus; Congenital Foot Deformities; Osteotomy Bone; Artery Supply Foot

1. Brockett CL and Chapman GJ. “Biomechanics of the ankle”. Orthopaedics and Trauma 3 (2016): 232-238.
2. Stirling P., et al. “Patient-reported functional outcomes and health-related quality of life following fractures of the talus”. Annals of The Royal College of Surgeons of England 6 (2019): 399-404.
3. De Boer AS., et al. “Health care consumption and costs due to foot and ankle injuries in the Netherlands, 1986-2010”. BMC Musculoskeletal Disorders 15 (2014): 128.
4. Hoffman M. “Picture of the Feet” (n.d.).
5. Gray H. “Anatomy of the human body”. London, England: Bounty (2012).
6. Foot Injuries | Foot Disorders | MedlinePlus. (n.d.).
7. Card RK and Bordoni B. “Anatomy, bony pelvis and lower limb, foot muscles”. StatPearls [Internet]. StatPearls Publishing Treasure Island (FL) (2023).
8. Calluses and Corns - Topic Overview. (n.d.).
9. Topographic anatomy of the lower extremity, part II: knee, leg, ankle, and foot [Video file] (n.d.).
10. Muscles of the foot (n.d.).
11. Tang A and Bordoni B. “Anatomy, bony pelvis and lower limb, foot nerves”. StatPearls [Internet]. StatPearls Publishing Treasure Island (FL) (2023).
12. Desai SS and Cohen-Levy WB. “Anatomy, bony pelvis and lower limb: tibial nerve”. StatPearls [Internet]. StatPearls Publishing Treasure Island (FL) (2023).
13. Mróz I., et al. “Blood vessels of the shin - anterior tibial artery anatomy and embryology - own studies and review of the literature”. Folia medica Cracoviensia 1 (2016): 33-47.
14. Chmielewski P., et al. “Blood vessels of the shin - posterior tibial artery - anatomy - own studies and review of the literature”. Folia medica Cracoviensia 3 (2016): 5-9.
15. Manzi M., et al. “Vascular imaging of the foot: the first step toward endovascular recanalization”. Radiographics 6 (2011): 1623-1636.
16. Garcia-Pumarino R., et al. “Vascular anatomy of the dorsum of the foot”. Plastic and Reconstructive Surgery 6 (2010): 2012-2018.
17. Kim JW., et al. “Anatomic study of the dorsalis pedis artery, first metatarsal artery, and second metatarsal bone for mandibular reconstruction”. Journal of Oral and Maxillofacial Surgery 8 (2015): 1627-1636.
18. Meyer-Marcotty MV., et al. “Anatomical study of the human sole of the foot by 4-dimensional CT angiographic vascular imaging - its suitability as composite tissue allotransplantation graft for foot defects”. Annals of Transplantation2 (2012): 79-85.
19. van den Berg JC. “Angiosome perfusion of the foot: An old theory or a new issue?” Seminars in Vascular Surgery 2-4 (2018): 56-65.
20. Psaltis PJ., et al. “Resident vascular progenitor cells--diverse origins, phenotype, and function”. Journal of Cardiovascular Translational Research 2 (2011): 161-176.
21. Sato Y. “Dorsal aorta formation: separate origins, lateral-to-medial migration, and remodeling”. Development, Growth and Differentiation 1 (2013): 113-129.
22. Resnick DL. “Diagnosis of bone and joint disorders”. Saunders. ISBN: 0721689213. Read it at Google Books - Find it at Amazon.
23. Reorganized text. JAMA Otolaryngology - Head and Neck Surgery 11 (1994): 428.
24. Stiell I., et al. “Multicentre trial to introduce the Ottawa ankle rules for 2. use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group”. British Medical Journal7005 (1995): 594-597.
25. Pathria MN., et al. “Acute and stress-related injuries of bone and cartilage: pertinent anatomy, basic biomechanics, and imaging perspective”. Radiology1 (2016): 21-38.
26. Gorbachova T., et al. “Nomenclature of subchondral nonneoplastic bone lesions”. American Journal of Roentgenology 5 (2019): 963-982.
27. Palmer WE., et al. “Knee and shoulder fractures: Association of fracture detection and marrow edema on MR images with mechanism of injury”. Radiology2 (1997): 395-401.
28. McKay DW. “New concept of and approach to clubfoot treatment: Section III. Evaluation and results”. Journal of Pediatric Orthopaedics 2 (1983): 141-148.
29. Ponseti IV. “Congenital clubfoot. Fundamentals for treatment”. Oxford: Oxford University Press (1996): 55.
30. Diméglio A., et al. “Classification of clubfoot”. Journal of Pediatric Orthopaedics B2 (1995): 129-136.
31. Ponseti IV., et al. “A radiographic study of skeletal deformities in treated clubfeet”. Clinical Orthopaedics and Related Research 160 (1981): 30-42.
32. Vanderwilde R., et al. “Measurements on radio-graphs of the foot in normal infants and children”. Journal of Bone and Joint Surgery: American Volume3 (1988): 407-415.
33. Cooper DM and Dietz FR. “Treatment of idiopathic clubfoot. A thirty-year follow-up note”. Journal of Bone and Joint Surgery: American Volume 77-A.10 (1995): 1477-1489.
34. Simons GW. “Complete subtalar release in clubfeet. Part I. A preliminary report”. Journal of Bone and Joint Surgery: American Volume 67-A.7 (1985): 1044-1055.
35. Harrold AJ and Walker CJ. “Treatment and prognosis in congenital club foot”. Journal of Bone and Joint Surgery: British Volume 65-B.1 (1983): 8-11.
36. Catterall A. “A method of assessment of the clubfoot deformity”. Clinical Orthopaedics and Related Research 264 (1991): 48-53.
37. Carroll NC. “Clubfoot”. In: Morrisy RT, ed. Lovell and Winter’s Pediatric Orthopaedics, 3^rd Philadelphia: JB Lippincott (1990): 927-956.
38. Swann M., et al. “The anatomy of uncorrected clubfeet”. Journal of Bone and Joint Surgery: British Volume2 (1969): 263-269.
39. McKay DW. “New concept of and approach to clubfoot treatment: Section III. Evaluation and results”. Journal of Pediatric Orthopaedics 2 (1983): 141-148.
40. Tuncay C., et al. “Comparison of the soft-tissue release methods in idiopathic clubfoot”. Journal of Pediatric Orthopaedics 5 (2000): 648-651.
41. Yamamoto H., et al. “Nonsurgical treatment of congenital clubfoot with manipulation, cast, and modified Denis Browne splint”. Journal of Pediatric Orthopaedics 4 (1998): 538-542.
42. Martin Pfeiffer., et al. “Prevalence of flat foot in preschool-aged children”. Pediatrics 2 (2009): 634-639.
43. Haendlmayer KT and Harris NJ. “Flatfoot deformity: an overview”. Orthopaedics and Trauma6 (2009): 395-403.
44. Chen KC., et al. “Relevant factors influencing flatfoot in preschool-aged children”. European Journal of Pediatrics7 (2011): 931-936.
45. Harris EJ., et al. “Diagnosis and treatment of flat feet in children”. Journal of Foot and Ankle Surgery 6 (2004): 341-373.
46. Rao UB and Joseph B. “The influence of footwear on the prevalence of flat foot”. Journal of Bone and Joint Surgery: British Volume4 (1992): 525-527.
47. Mosca VS. “Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot”. Journal of Bone and Joint Surgery: American Volume4 (1995): 500-512.
48. Ettl V., et al. “Calcaneal lengthening for planovalgus deformity in children with cerebral palsy”. Foot and Ankle International 5 (2009): 398-404.
49. Evans AM. “Pocket Podiatry: Paediatrics E-Book”. Elsevier Health Sciences (2010).
50. Murley GS., et al. “A protocol for classifying normal and flat-arched foot posture for research studies using clinical and radiographic measurements”. Journal of Foot and Ankle Research 2 (2009): 22.
51. Tudor Anton., et al. “Flat-footedness is not a disadvantage for athletic performance in children aged 11 to 15 years”. Pediatrics 3 (2009): e386-e392.
52. Harris RI and Beath T. “Hypermobile flatfoot with short tendo Achilles”. Journal of Bone and Joint Surgery: American Volume1 (1948): 116-140.
53. Evans D. “Calcaneo-valgus deformity”. Journal of Bone and Joint Surgery: British Volume3 (1975): 270-278.
54. Thometz J. “Tarsal coalitions”. Foot and Ankle Clinics 1 (2000): 103-117.
55. Tax H R. “Podopediatrics (2^nd edition)”. Baltimore: Williams and Wilkins (1985).
56. Tachdjian MO. “The foot and leg. Paediatric orthopaedics 4”. Philadelphia: W B Saunders (1990).
57. Trott AW. “Children's foot problems”. Orthopaedic Clinics of North America3 (1982): 641-654.
58. Berg EE. “A reappraisal of metatarsus adductus and skewfoot”. Journal of Bone and Joint Surgery 8 (1986): 1185-1196.
59. Cornwall MW., et al. “The relationship between forefoot alignment and rearfoot motion during walking”. Australasian Journal of Podiatric Medicine 2 (2004): 35-40.
60. Rushforth C. “The natural history of hooked forefoot”. Journal of Bone and Joint Surgery4 (1978): 530-532.
61. Chong A. “A new device for the measurement of Metatarsus Adductus”. Journal of Prosthetics and Orthotics 2 (1991): 139-148.
62. Bleck EE. “Metatarsus adductus: classification and relationship to outcomes of treatment”. Journal of Pediatric Orthopaedics 1 (1983): 2-9.
63. Robinson DS., et al. “Dwyer osteotomy for treatment of calcaneal varus”. Journal of Foot and Ankle Surgery 6 (1988): 541-544.
64. Bernhardt DB. “Prenatal and postnatal growth and development of the foot and ankle”. Physical Therapy12 (1988): 1831-1839.
65. McHale KA and Lenhart MK. “Treatment of residual clubfoot deformity-the “bean-shaped” foot-by opening wedge medial cuneiform osteotomy and closing wedge cuboid osteotomy. Clinical review and cadaver correlations”. Journal of Pediatric Orthopaedics 3 (1991): 374-381.
66. Heyman CH., et al. “Mobilization of the tarsometatarsal and intermetatarsal joints for the correction of resistant adduction of the fore part of the foot in congenital clubfoot or congenital metatarsus varus”. Journal of Bone and Joint Surgery: American Volume2 (1958): 299-309.
67. Simons GW. “Analytical radiography of club feet”. Journal of Bone and Joint Surgery: British Volume4 (1977): 485-489.
68. Reimann I and Becker-Andersen H. “Early surgical treatment of congenital clubfoot”. Clinical Orthopaedics and Related Research 102 (1974): 200-206.
69. Lowe LW and Hannon MA. “Residual adduction of the forefoot in treated congenital club foot”. Journal of Bone and Joint Surgery: British Volume4 (1973): 809-813.
70. Rothbart BA. “Metatarsus adductus and its clinical significance”. Journal of the American Podiatric Medical Association 5 (1972): 187-191.
71. Dwyer G. “The measurement of Metatarsus Adductus - a step forward in clinical evaluation”. Unpublished Graduate Diploma Thesis, Perth: Curtin University (1989).
72. Coleman SS. “Complex Foot Deformities in Children”. Philadelphia, Lea and Febiger (1983): 94-98.
73. Turco VJ. “Resistant congenital club foot - one-stage posteromedial release with internal fixation: a follow-up report of a fifteen-year experience”. Journal of Bone and Joint Surgery: American Volume6 (1979): 805-814.
74. Lowe LW and Hannon MA. “Residual adduction of the forefoot in treated congenital club foot”. Journal of Bone and Joint Surgery: British Volume4 (1973): 809-813.
75. Main BJ and Crider RJ. “An analysis of residual deformity in club feet submitted to early operation”. Journal of Bone and Joint Surgery: British Volume 4 (1978): 536-543.
76. Otremski I., et al. “An analysis of the results of a modified one-stage posteromedial release (Turco operation) for the treatment of clubfoot”. Journal of Pediatric Orthopaedics2 (1987): 149-151.
77. Hung NN., et al. “An opening wedge medial cuneiform osteotomy with closing wedge cuboid osteotomy combined fibular allograft for metatarsus adductus in children”. EC Orthopaedics2 (2018): 42.