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A case of congenital cleft foot deformity, also known as lobster claw or split foot, is presented. The condition is rare. A review of the literature reveals that this deformity will often coexist as part of a constellation of congenital and familial abnormalities. Surgical correction of the cleft foot is difficult and often deferred.
In correcting foot deformities the author observed a constant relationship between the forefoot and the hindfoot. If the forefoot is adducted, the heel automatically goes into the varus position. On the other hand, abduction of the forefoot will result in a valgus position of the heel. This rule was investigared and validified by experiments on cadavers: it was shown that the position of the hindfoot is automatically normalized by the correction of the forefoot. Our observations have been confirmed by treating foot deformities in children and adults. Therefore we believe that surgery of the talo-calcaneal joint in cases of foot deformity is unnecessary.
In order to analyze foot deformities, the foot is divided into three compartments. Their normal and pathological positions are defined by the alignment of the bones' axes. The various foot deformities can be put down to a malalignment of the particular compartments. X-ray analysis of the malalignment allows a diagnosis to be made. The most important congenital and acquired foot deformities are discussed.
Foot deformities may reflect a generalized disorder, especially a neurologic problem; thus, the child should have a brief general examination. Many infantile foot deformities, such as calcaneovalgus, are postural and self-correcting. Metatarsus varus is not referred for treatment until age 2 months and then only if the deformity is moderate or severe. Fixed forefoot equinus and heel varus characterize a clubfoot, which requires immediate treatment. Corrective shoes are not advised as the primary treatment for metatarsus varus or clubfoot but often are prescribed to maintain the corrected position after serial casts. Flexible flatfoot is a manifestation of a constitutional laxity affecting all ligaments and joints. The feet appear abnormal because of weight-bearing stresses. Most children with flatfoot achieve a partial correction spontaneously. Current research does not document that treatment with corrective shoes or inserts produces a result better than the partial correction that occurs naturally.
A clinical survey on foot deformities among 166 geriatric inpatients was carried out. Direct measurements on hallux valgus, great toe movements, great toe deformities, lesser toe deformities, arch of the foot, callosities, ankle movements, inversion, and eversion were done by using the goniometer. A specially designed goniometer was created to measure inversion and eversion. The Harris Mat was used to study foot prints in correlation with the various deformities. About 50% of geriatric patients were found to have foot deformities of various types. This compared well with available data in literature. The target population was also checked for their symptomatology which, amazingly, was found to be really insignificant compared with the deformities present. This finding was found to be very much unlike data for Caucasian individuals with foot deformities, 50% of whom had symptoms related to pain and footwear. This major difference in the clinical presentation encourages the authors to carry on their study and, perhaps, direct cross-cultural studies in the future.
This article presents the most common structural foot deformities encountered in clinical practice. The deformities are defined, and the expected compensations at the subtalar joint (STJ) are described. The theoretical consequences of the STJ compensations on proximal and distal tissues are presented. A biomechanical rationale for certain tissue disorders is described. The possible effects of abnormal STJ compensation on osseous development are briefly discussed.
This paper describes a simplified technique for split posterior tibial tendon transfer in the treatment of spastic equinovarus deformity of the foot. Thirteen children with spastic equinovarus foot deformities were treated at Children's Rehabilitative Services in Phoenix, Arizona, from 1983 to 1986. The technique was modified in 10 of the 13 patients by attaching the split posterior tibial tendon more proximally to the peroneus brevis, compared to a more distal attachment as described by other authors. The mean length of followup was 21 months. Eleven patients obtained a good or excellent result. Two patients were considered to have a fair result. No poor results or complications were noted in any of the patients. It was felt that the split posterior tibial tendon transfer was an effective procedure for correction of spastic equinovarus as reported by other authors. Modification of the technique significantly simplifies the operation by requiring less dissection while still producing favorable results.
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In a consecutive screening of 2,401 newborn, a foot deformity was noted in 100 of the infants (4.2 percent). At follow-up 5-6 years later, the children with a foot deformity were reexamined and compared with normal controls. Seventy-six infants had some adduction deformity of the foot at birth. At reexamination, 87 percent of the examined children had normal feet. No association was observed between sleeping prone and the presence of adduction deformity at the reexamination. Pes calcaneovalgus was diagnosed in 18 newborn. Of those reexamined, all had normal feet. Up to the age of 6 years, 4.3 percent of the 2,401 had been referred to the department of orthopedics because of a foot deformity; 50 because of an adduction deformity, and in 10 of these children the deformity was observed at birth. The investigation indicates that no treatment is required for pes calcaneovalgus or adductus deformity confined to the forefoot.
The Ilizarov method is being used increasingly to correct many orthopedic deformities. The frames required for ankle and foot deformity correction are among the most difficult to construct owing to the complexity of the deformities which must be corrected. A technique using a rubberized material (Pedilen) to create an exact replica of a preoperative ankle and foot deformity is described. This exact model, both in size and shape, may then be used on a workbench to preconstruct an Ilizarov frame that resembles the patient's deformity exactly in three dimensions with respect to size and shape. This allows thoughtful frame construction before operation reducing operating time and minimizing frustrations that may arise with complex deformities.
The purpose of this study was to determine whether a relationship existed between type of foot deformity and the location of ulcers in patients with diabetes and insensitive feet. Forty-two ulcerated feet were examined in 40 patients. All patients had severely decreased or absent sensation. Foot deformities were classified according to operational definitions as 1) Charcot's foot, 2) a compensated forefoot varus, or 3) an uncompensated forefoot varus or forefoot valgus. The plantar surface of the midfoot and forefoot was divided into three regions. Six of the 7 patients with a Charcot's foot showed ulceration at the midfoot. Nine of 18 patients with a compensated forefoot varus showed ulceration at the second, third, or fourth metatarsal head. Fifteen of 17 patients with an uncompensated forefoot varus or forefoot valgus showed ulceration at the first or fifth metatarsal. A significant relationship was found between foot deformity and location of ulcer. These results support the hypotheses 1) that insensitivity, coupled with increased, repetitive pressure, is a primary cause of plantar ulcers and 2) that certain foot types are associated with characteristic patterns of pressure distribution and callus formation.
A retrospective clinical and radiologic study was made of 16 children with foot deformities and associated occult spinal abnormalities in a 3-year period. Eleven children had bilateral foot deformities; the deformities were unilateral in five. Midline cutaneous lesions of the back were noted in 13 children; the most common dermal sign was a hairy patch. All children had radiologic features of spinal dysraphism on combined computed tomography (CT) scan and myelogram. Spinal dysraphism was not considered in the initial assessment of four children. Children with foot deformity should therefore have a careful assessment of the spine, including a neurologic evaluation.
A list of syndromes that include foot deformities as part of the clinical presentation has been compiled and subdivided into a descriptive classification. A brief discussion is presented of the embryology of the foot as it pertains to and helps explain the etiology of these various anomalies. Variations in the treatment of arthrogryposis multiplex congenita and ring constrictions are described. Finally, unique foot configurations are documented, which if seen should alert the clinician to consider the diagnosis of a specific syndrome.
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The authors present a brief survey of the essential possibilities of technical aids provided for patients with diseases and defects of feet. The work deals with fundamental indications for the application of various ways of technical solution and is supplemented with pictures.
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The change of gait in stroke patients after gait training or surgery for foot deformity was analyzed according to walking cycle and gait speed and cadence by means of the accelorometer or the large force plate. The results were summarized as follows. Twenty patients receiving gait training. Variation of the stride duration decreased gradually on both sides. The stance phase and the double support phase had the tendency to demonstrate equal percentage on both sides, decreasing in the unaffected side. The percentage values were higher than those in the normal person except a few cases. The cadence increased in all cases except one. Twenty-two patients following surgery for foot deformities. Walking cycle revealed almost the same result as that of cases receiving gait training. The percentage of the double support phase in the unaffected side characteristically approached that of the affected side after surgery, suggesting surgical benefits. Cadence decreased in 7 cases, while gait speed increased in all cases. It may come from the wider stride length after surgery.
A intermarried consanguineous family with split-hand and -foot deformity occurring in two sibship is presented. Both the sibship resulted from marriage between first cousins. This report, together with those of Ray (1960) and Freire-Maia (1971), further demonstrates that split-hand and -foot deformity can be inherited as an autosomal recessive trait.