Forefoot
and digital problem
Revise
2nd year biomechanics course material on digital
deformity and hallux abducto valgus
ePodiatry's
links on lessor
toe deformities, hallux
abducto valgus and other first
MPJ disorders
Digiti Quinti Varus/Contracted under riding fifth
toe
Also called – digiti minimi varus
A transverse and frontal plane deformity of the toe where the fifth
digit is rotated into a varus or inverted position.
Aetiology:
Generally congenital
Familial predisposition/inherited factors.
Clinical Features:
Most asymptomatic.
Fifth digit under rides the fourth toe – proximal IP joint
is in varus position.
Heloma molle may arise from the pressure interdigitally from the
rotation of the ‘heads’ of the phalanges.
Management:
Generally not needed.
Treat inflammation and hyerkeratotic lesions.
Surgery
Footwear advice
Overlapping fifth toe
A sagittal, frontal and transverse plane deformity
of the fifth toe in which it over rides/overlaps the fourth toe.
Soft tissues usually contracted.
Aetiology – may be due to pressure in utero;
failure of proper development of MPJ
Clinical features – fifth toe overrides fourth
– toe is adducted, dorsiflexed and in varus rotation at the
MPJ; usually asymptomatic in children – digital lesions can
develop later
Treatment:
Splint/retainer; strapping
Surgical – sequential soft tissue releases or amputation
‘Curly Toes’
A common childhood deformity of the lessor toes
where one or more may be flexed at the IPJ’s and rotated in
a varus position – often underlapping.
Aetiology
Usually congenital; Could be due to intrauterine pressure;
Aggravated by footwear
Clinical Features:
Usually a full range of motion; Usually bilateral; Usually
the 3rd to 5th toes; As children grow, the deformity becomes less
extreme – but may have hyperkeratotic lesions
Management:
Reassurance
Splinting
Treat lesions
Surgery for significant cases
Macrodactylia
/ Macrodactylism / Localised gigantism
Rare congenital deformity of the digits where there
is an enlargement of one or more toes (usually adjacent).
Cause unknown – may be related to hyperplastic vascular and
lymphatic elements.
Most occur as an independent deformity, but is can be associated
with general syndromes. Eg neurofibromatosis.
Large amounts of fat are seen in the bone marrow, dermis and muscle;
periosteal thickening is common; tendon size is usually normal
Ingrown nails are common due to large fleshy nail folds.
Treatment is by partial amputation or reduction of soft tissue masses.
Microdactylia
Abnormally small digits – usually due to
an embryological development arrest. They may be an isolated deformity
or associated with other foot disorders.
Only treatment is amputation if they are problematic
Syndactylism
A deformity of the digits where there is a joining
of two or more digits. The webbing between the toes from the early
foetal stages of growth persist.
Most common congenital deformity of the feet. Partial syndactylism
between the second and third toes is common.
May be simple (fusion of skin and soft tissues of adjacent toes)
or complex (bone involved)
Most are congenital - can occur traumatically after burns
Transmitted as an autosomal dominant trait.
Types:
1) Partial or complete webbing between seond and third toes; most
common
2) One soft tissue mass covering the 4th, 5th, and maybe 6th toe
3) Associated with metatarsal fusion
Treatment:
Cosmetic surgical correction – usually done for psychological/emotional
reasons
Polydactylism / Supernumerary Digits
A congenital condition characterised by the presence
of extra or accessory digit(s) on the hands or feet. The extra digit
can be whole, but is often rudimentary and bilateral – may
develop from one metatarsal or there may be a complete supernumerary
metatarsal.
Cause unknown, but probably genetic – may be irregular autosomal
dominant inheritance. Associated with a number of syndromes - Down
Syndrome, Lawerence-Moon-Biedl syndrome.
Types/variants:
• Postaxial polydactyly – most common (~80%); Temtamy
& McKusick (1969) types: Type A is a fully developed accessory
digit and Type B less developed accessory digit (no osseous structures);
Venn-Watson (1976) types: complete duplication of metatarsal, Y-shaped
metatarsal, T-shaped metatarsal, wide metatarsal head, soft tissue
duplication
• Preaxial polydactyl – Temtamy & McKusick (1969)
4 types – duplication of first digit, polydactyly of a triphalangeal
first digit, polydactyly of the second digit, polysyndactyly
• Central ray polydactyly
Problems are usually associated with footwear fitting or cosmetic
concerns.
Treatment is by surgical removal if indicated – usually at
a younger age.
ePodiatrys
links on digital
problems in paediatric patients
|
Metatarsus
adductus
Three primary types:
1) Metatarsus adductus (transverse plane only)
2) Metatarsus adductus varus (transverse and frontal plane)
3) ‘Skewfoot’/compensated metatarsus adductus –
metatarsus adductus varus with rearfoot inverted.
Aetiology unknown – congenital and environmental
factors have been implicated – does resemble foot at about
6th to 8th foetal week.
Clinical features:
Adducted forefoot; medial border is concave; lateral border convex
– styloid process is prominent; often have wider space between
first and second toes; heel may be everted. Will generally have
no limitation of motion at the ankle joint that occurs in talipes
equinovarus.
Can be rigid, semirigid/semiflexible or flexible.
Treatment:
Flexible --> manipulation/stretching by parents + casting.
Casting is preferable before child is ambulatory (rearfoot is held
neutral or slightly inverted and forefoot is held abducted by apply
counter pressure after cuboid and fifth metatarsal base is stabilised)
Rigid or unresponsive to casting --> surgery.
Follow up treatment with orthoses, padded shoes or bars/splints.
ePodiatry's
links to metatarsus
adductus
|
