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Jordan University

Freih Odeh AbuHassan,

F.R.C.S.(Eng.),F.R.C.S.(Tr.& Orth.)

Professor of Orthopedics

The University of Jordan

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*Hip =Anteversion

=Retroversion

=Internal rotation

=External rotation

*Knee =Varus

=Valgus

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Jordan University

*Ankle = Equinus (Plantar flexion)

= Calcaneus (Dorsiflexion)

= Varus

= Valgus

*Subtalar Joint = Inversion

= Eversion

*Foot = Adduction

= Supination

= Pronation

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Jordan University

Knee & leg disorders1-Angular deformity

=Bow legs =Knock knees

2-Rotational deformity

3-Tibial bowing=Congenital bowing

=Cong. pseudoarthrosis of tibia

=Tibial hemimelia

=Fibular hemimelia

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Jordan University

Bowlegs Knock knees

Varum Valgum

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Jordan University

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Jordan University

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Jordan University

= Physiological

= Pathological

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Jordan University

N. up to 3 Y old

Common 3 - 7 Y

RESOLVE by 8-10 Y

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1- Metabolic e.g rickets, renal.

2- Skeletal dysplasia, M.P.

3- Blount’s

3- Growth disturbance injury or

infection.

4- Tumors: Osteochondroma,

Olliers, neurofibromatosis

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Jordan University

Rickets

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Skeletal dysplasiaM D

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Jordan University

Tibia vara (Blount’s dis.)

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Jordan University

= Shoe modifications

= Exercises to correct deformity

= Manipulation and encouraged

posture for sitting

= Orthosis

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The occurrence of the physiological

variations at that time was considered

as a manifestations of serious disease

= Correction of the deformity.

= Delighted family

= The physician impressed

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Jordan University

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Jordan University

Shoe wedges

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Jordan University

KAFO = Long leg braces

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Jordan University

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Jordan University

No relation between bowlegs & O.A

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

Intoe gait

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Jordan University

*<1y Metatarsus A

*1-3 y Med.tibial T.

*3-10 y Med.femoral T.

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Jordan University

Metatarsus Adductus Dx: Medial deviation of the forefoot or

metatarsals ,on neutral Hind foot.

(I.U malposition)

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Jordan University

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Jordan University

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Jordan University

Mangement

1- 90% resolve at walking age.

(no value of straight or reverse shoes)

2- Stretching + Cast.

*For failure of correction after 1Y.

*Rigid adductus 10%(Deep med. crease).

3- Soft tissue surgery at 5y.

4- Bony surgery after 8y.

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

Tibial torsion

Treatment•Spontaneous correction

•No value of Denis-browne bar,

heel wedges or any orthosis

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Jordan University

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Jordan University

Femoral Torsion

*>in girls, prefers to sit W position

*On standing & walking the

patella pointing inwards

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Jordan University

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Jordan University

Mangement

*No R/ < 8-10 years of age.

*Spontaneous correction

*Rarely surgical corrections

needed (<0.001%)

*No value of using twisting

cables , night splints Or

inverted shoes.

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Jordan University

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Jordan University

*Bilat.

1.Lat. torsion of the hip secondary

to I.U. position--Tight Ext. rot.

2.Bilat. Calcaneovalgus.

3.Ext. tibial torsion.

Out-toeing

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Jordan University

= Congenital bowing

= Cong. pseudoarthrosis of

tibia

= Tibial hemimelia

= Fibular hemimelia

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1-Cong.Post.med angulation

of the T&F - Kyphosis

Calcaneo valgus foot.

Congenital bowing

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= Calcaneus position of the foot.

= Dorsiflexion contracture of the

ankle.

= Calcaneo valgus foot.

= Limited plantar flexion of foot.

= Small Calf.

At birth

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Jordan University

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Jordan University

2-Cong. Ant.lat.

ang. of the T&F

- Lordosis.

Cal. varus foot

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Jordan University

Cong. pseudoarthrosis of tibia

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Jordan University

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Jordan University

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Jordan University

1-Calcaneovalgus deformity

2-Metatarsus adductus

3-Cong. talipus equinovarus

4-Flat feet

5-Neurogenic foot

-C.P -Polio. -Spinal diseases

Feet disorders

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Calcaneovalgus deformity

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CTEV

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• Incidence: 1 in 1000

• M:F ratio 2:1

• Bilateral in 1/3 of cases

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Jordan University

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Jordan University

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Jordan University

Flat Feet

No Longitudinal arch of the foot

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Types

Physiological Pathological

* Very common. * Rare

* Flexible. * Stiff.

* Asymptomatic. *

Symptomatic!!

* > 99%. * < 1%.

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How to assess flat feet?.

* Observe the feet standing, tip toes,

sitting.

* Check flexibility.

-Dorsiflexion! (T.A.).

-Inversion and Eversion.

-Pronation & Supination.

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Jordan University

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Jordan University

Physiological flat feet.

*Nearly all infants.

*Most children.

*15% of normal adult.

JBJS-A, 1987, Staheli.

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P.F to Physiological flat

feet

*Hereditary.(Familial)

*Genu valgum.

*Limb torsion.

*Generalized laxity.

*Over weight.

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Low arch feet & high

arch feet.

*Less stress inj. with low arch.

*High arch more stress inj.

*Low arch better than high arch

for military recruits.

Giladi etal 1985.

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Pathological flat feet

1.Congenital : CVT.

2.Painless :-Tight T.A.

-Paralytic (C.P,Spina B.)

3.Painful or peroneal spasmodic flat feet.

- Tarsal coalition

- Accessory navicular bone

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Jordan University

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Jordan University

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Jordan University

Prospective

controlled

study

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Jordan University

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Jordan University

Neurogenic disorders

The real indications

for Orthosis

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Jordan University

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Jordan University

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Jordan University

Nerve injury

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Jordan University

AppliancesDeformityML-paralysed

AFO + inside bar

&Outside T strap

InversionEvertors1-Foot

AFO + 90 / foot

drop stop

Foot dropDorsiflexors2-Ankle

AFO + reverse 90/

stop

CalcanecusPlantar Flexors

AFO + limited

motion ankle joint

Flail foot All muscles 3-Ankle

&Foot

KAFO +back knee

support

Genu

Recurvatum

Extensor:

quadriceps4- Knee

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Jordan University

Orthosis used only for

abnormal child or child

with chronic problem

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Jordan University

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Jordan University

Normal child needs

normal shoes

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Jordan University

12

3

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Jordan University

Severe

Family

History

Unilat.

Short

stature

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Jordan University

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