.bmp)
Calcaneovalgus is a fairly common finding in the foot of a newborn. It is defined as a positional deformity where the foot is in a dorsiflexed (with the foot pointed upwards) position, and the calcaneus is in a valgus position (with the heel rotated outwards). It is often described as an “up and out” appearance. It is more commonly seen in females than in males, and can present in up to 10% of live births. It can be seen in either foot, or both. The deformity is generally flexible, which improves the prognosis.
The exact cause of calcaneovalgus is unknown in most cases, however, it is presumed by many that it is the result of an increase in intrauterine pressure that causes the positional deformity. In some cases, particularly the more severe forms, calcaneovalgus may be the result of a muscle imbalance due to an underlying neurological issue such as myelomeningocele.
Some clinicians argue against the treatment of calcaneovalgus, citing the fact that many cases will spontaneously resolve as the child ages and begins to walk. However, an untreated case of calcaneovalgus, particularly in cases of moderate to severe deformity, can result in symptomatic flatfoot beginning in childhood and lasting through adulthood.
The diagnosis is made most commonly through clinical evaluation, looking for signs such as the up and out appearance, increased skin folds on the anterior ankle, and other findings. In some cases, the top of the foot (dorsum) is able to reach the anterior ankle (shown in the middle picture above). X-rays may also be used to confirm the positional deformity of the foot, and are often used to rule out other deformities as well as to track the progression of calcaneovalgus.
The treatment of calcaneovalgus is dependent on the severity of the deformity. For mild cases, treatment may include manipulation of the foot in infancy, and supportive shoes in early childhood.
Cases of moderate calcaneovalgus may involve further intervention, with various types of bracing and splinting, supportive shoes, night splints, orthotics, and other conservative treatment measures aimed at minimizing the progression of the deformity.
More severe cases may involve serial casting beginning in infancy. This involves setting the foot into alignment, and placing it in a plaster cast. Gradually, the deformity is placed more and more into an appropriate position, and serial casting is used to keep the foot in place. Orthotics are likely to be used through early childhood to prevent residual deformity or relapse. The incidence of a severe calcaneovalgus deformity is roughly one in a thousand live births.
No comments:
Post a Comment