Disorders of Foot Alignment
Transcript of Disorders of Foot Alignment
![Page 1: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/1.jpg)
Disorders of Foot Alignment
Tal Laor, M.D. Cincinnati Children’s Hospital Medical Center
University of Cincinnati College of Medicine
SPR Pediatric MSK Imaging Austin, TX, Jan 2016
![Page 2: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/2.jpg)
Ossification Centers Newborn:
• Metatarsals and
phalanges
– (fetal 8-12 wks)
• Calcaneus
– (fetal 23-24 wks)
• Talus
– (fetal 26 wks)
• Cuboid
– (at birth)
C T
Cu
T C
Cu
![Page 3: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/3.jpg)
Navicular bone:
•2-5 years
•eccentric ossification
![Page 4: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/4.jpg)
• Talipes: (Latin talus = ankle,
pes = foot) congenital foot and
ankle deformity
• Pes: (Latin: foot) “acquired” foot
deformity
Terminology
![Page 5: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/5.jpg)
• Hindfoot:
talus and calcaneus
• Midfoot: navicular,
cuneiforms, cuboid
• Forefoot:
metatarsals, phalanges
F
M
H
Terminology
![Page 6: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/6.jpg)
Varus Valgus
mid
line
mid
line
(eversion, pronation) (inversion, supination)
konnectad.com
konnectad.com morphopedics.wikidot.com
morphopedics.wikidot.com
![Page 7: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/7.jpg)
Radiologic Evaluation
• AP and lateral weight-bearing or
simulated weight-bearing
• Additional:
– flexion (dorsal or plantar)
– tangential (Harris-Beath)
– 45 degree medial oblique views
![Page 8: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/8.jpg)
![Page 9: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/9.jpg)
Normal Anatomy Lateral View (weight-bearing)
![Page 10: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/10.jpg)
Normal Anatomy Lateral View (weight-bearing)
![Page 11: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/11.jpg)
Normal Anatomy Lateral View (weight-bearing)
• Tibial-calcaneal angle
= 70 - 90o
![Page 12: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/12.jpg)
![Page 13: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/13.jpg)
Equinus
![Page 14: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/14.jpg)
Equinus
•Fixed calcaneal plantarflexion
•Tibial-calcaneal angle >90o
vim.org equmed.com barnmice.com
![Page 15: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/15.jpg)
![Page 16: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/16.jpg)
Calcaneus
![Page 17: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/17.jpg)
Calcaneus
• Fixed calcaneal
dorsiflexion
• Tibial-calcaneal angle
< 60o
![Page 18: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/18.jpg)
hss.edu
![Page 19: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/19.jpg)
Normal Anatomy Lateral View (weight-bearing)
![Page 20: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/20.jpg)
•Talo-calcaneal angle = 30o- 45o
Normal Anatomy Lateral View (weight-bearing)
![Page 21: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/21.jpg)
![Page 22: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/22.jpg)
Normal Anatomy AP View (weight-bearing)
![Page 23: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/23.jpg)
• Talo-calcaneal angle
= 30°- 45o
(decreases with age)
Normal Anatomy
![Page 24: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/24.jpg)
turbosquid.com
![Page 25: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/25.jpg)
turbosquid.com
Everything revolves around
the talus
worldofstock.com
![Page 26: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/26.jpg)
Normal AP View medial lateral
![Page 27: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/27.jpg)
C T
![Page 28: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/28.jpg)
Hindfoot valgus
C T
![Page 29: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/29.jpg)
Hindfoot valgus
![Page 30: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/30.jpg)
C T
5
![Page 31: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/31.jpg)
Hindfoot varus
C T
5
![Page 32: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/32.jpg)
Hindfoot varus
![Page 33: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/33.jpg)
![Page 34: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/34.jpg)
Hindfoot Valgus
• Axis of talus is
medial to 1st MT
• Talo-calcaneal
angle > 45°
![Page 35: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/35.jpg)
Hindfoot Valgus
![Page 36: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/36.jpg)
• Increased
talo-calcaneal
angle > 45°
Hindfoot Valgus
![Page 37: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/37.jpg)
![Page 38: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/38.jpg)
•Axis of talus is lateral to 1st MT
•Talo-calcaneal angle < 30°
Hindfoot Varus
![Page 39: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/39.jpg)
Hindfoot Varus
![Page 40: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/40.jpg)
• Talo-calcaneal angle < 30o
Hindfoot Varus
![Page 41: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/41.jpg)
![Page 42: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/42.jpg)
Hindfoot Alignment
Normal
midline
Valgus Varus
N
![Page 43: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/43.jpg)
Normal Valgus Varus
N
natashascafe.com 123rf.com amazon.com
midline
![Page 44: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/44.jpg)
• 10x’s more common than clubfoot
• “Intrauterine packing”
• 1-10% incidence of developmental dysplasia of the hip (DDH)
• Radiographs: rigidity, other deformities
orthoinfo.aaos.org
Metatarsus Adductus
![Page 45: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/45.jpg)
Metatarsus Adductus
• Normal talo-
calcaneal angle
• Adducted forefoot
![Page 46: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/46.jpg)
![Page 47: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/47.jpg)
Clubfoot (talipes equinovarus)
• 1-4:1000 live births
• Boys > girls
• Unilateral > bilateral
• Multifactorial inheritance
modified by intrauterine and
environmental factors
zadeh.co.uk
![Page 48: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/48.jpg)
•Equinus
•Hindfoot varus
Clubfoot
![Page 49: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/49.jpg)
Clubfoot
•Hindfoot varus
![Page 50: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/50.jpg)
•Hindfoot varus
•Forefoot varus
Clubfoot
![Page 51: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/51.jpg)
![Page 52: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/52.jpg)
![Page 53: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/53.jpg)
• For clubfoot
– Tibial-calcaneal angle (does equinus alignment
improve?)
– Talo-calcaneal angle
Additional Views Maximal Dorsiflexion
![Page 54: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/54.jpg)
• Standard in infants, common in
children
• Radiographs for rigidity, loss of
subtalar motion
• Treatment for pain, severe
progression
• Longitudinal arch reconstitutes
Flexible Flatfoot (pes planus, flattened longitudinal arch)
zadeh.co.uk
babiesnkids.blogspot.com
![Page 55: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/55.jpg)
• Normal heel
• Hindfoot valgus
• “Relaxed talus”
• Talonavicular association
on lateral view maintained
Flexible Flatfoot
![Page 56: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/56.jpg)
![Page 57: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/57.jpg)
Hindfoot Valgus
• Hindfoot valgus
![Page 58: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/58.jpg)
![Page 59: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/59.jpg)
Congenital Vertical Talus (congenital rigid rocker-bottom foot, congenital flatfoot with
talonavicular dissociation)
• Most severe form of congenital rigid flatfoot
• Plantar surface of foot is convex (rocker-bottom)
• Associated with neuromuscular imbalance
• Contracted soft tissues; all eventually need surgery
doctor-rabat.net
![Page 60: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/60.jpg)
• Equinus heel
• Extremely plantarflexed talus
• Hindfoot valgus
• Talonavicular dissocation
Congenital Vertical Talus
![Page 61: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/61.jpg)
Additional Views Maximal Plantarflexion
• For congenital vertical talus – does talo-
navicular dissociation persist? (use cuboid
if navicular is unossified)
Cu Cu
![Page 62: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/62.jpg)
andrearosen.com
![Page 63: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/63.jpg)
Flat Foot
Flexible Flatfoot Congenital Rigid (pes planus) (congenital vertical talus)
Hindfoot valgus Hindfoot valgus
Normal heel Equinus heel
Talonavicular association Talonavicular dissociation
Reconsituted arch No change with flexion
![Page 64: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/64.jpg)
Skewfoot (Z-foot, S-foot)
• Rigid
• Hindfoot valgus: resembles flatfoot
• Forefoot varus: resembles clubfoot
![Page 65: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/65.jpg)
Skewfoot (Z-foot, S-foot)
• Hindfoot valgus,
• Rigid forefoot varus
![Page 66: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/66.jpg)
![Page 67: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/67.jpg)
Adolescent Bunion (hallux valgus)
• Girls > boys
• 12-15 years
• Normal range of
motion, no arthritis,
less severe deformity
(vs adults)
• Surgery: pain,
difficulty with shoes
![Page 68: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/68.jpg)
Adolescent Bunion (hallux valgus)
“bunio” (Latin)
![Page 69: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/69.jpg)
• Medial prominence, uncovering of
head of 1st metatarsal
• Incr intermetatarsal angle (>10o)
• Incr 1st metatarsal-phalangeal
angle (>15o)
• Lateral subluxation of sesamoid
bones
Adolescent Bunion (hallux valgus)
![Page 70: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/70.jpg)
>10°
![Page 71: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/71.jpg)
>15°
![Page 72: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/72.jpg)
Bunionette
Oestreich AE, How to Measure Angles from Foot Radiographs. 1990.
![Page 73: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/73.jpg)
![Page 74: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/74.jpg)
YOUR TURN
![Page 75: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/75.jpg)
![Page 76: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/76.jpg)
![Page 77: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/77.jpg)
![Page 78: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/78.jpg)
• >90 degrees: equinus
![Page 79: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/79.jpg)
• >90 degrees: equinus
• Incr talo-calc angle: hindfoot
valgus
![Page 80: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/80.jpg)
• >90 degrees: equinuus
• Incr talo-calc angle: hindfoot
valgus
• Plantar-flexed talus with
presumed talo-navicular
dissociation =
• CONGENITAL VERTICAL
TALUS
![Page 81: Disorders of Foot Alignment](https://reader030.fdocuments.us/reader030/viewer/2022012409/616a4efc11a7b741a3511511/html5/thumbnails/81.jpg)
Thank you!