Foot deformity

Foot deformity
Classification and external resources
Specialty medical genetics
ICD-10 M20-M21, Q66
ICD-9-CM 734-735, 755.6
MeSH D005530

The foot is a vital organ in our daily life that enables our mobility. It is a well-designed anatomical structure that requires little attention for the normal functioning. Anatomically, a foot is a complex structure; consist of 26 pieces of bone, many ligaments and muscle bundles working together to support the entire body weight and distributing it to the ground by the curve of the foot or sole.[1]

The abnormality of feet affects the leg and knee and lead to the muscle pains. This occurs due to the unbalanced arrangement of the bones. Consequently, the results of the flatting arch are a twisted ankle, tilting inward freeze or bending tendons in the foot. Correct medical management may prevent the deformity from getting worse. The common deformities of the foot include hammertoe, clubfoot, flat feet and pes cavus.[1][2]

Hammer toe

Hammer toes are common and painful deformities in the 3 middle toes where they appear to always bent. A patient may have a single or multiple hammer toes. The deformity develops most commonly in a longer toe, and a toe with increased length is at increased risk for the development of hammer toe deformity.[3]

Hammer Toe

Symptoms[3][4]

The main symptom of a hammer toe deformity is pain and pressure over the dorsal aspect of the proximal interphalangeal joint, which is often associated with a hypertrophic callus on the dorsal side of the digit. It becomes difficult to wear a constricting shoe because of pressure against the contracted digit. When the metatarsophalangeal joint become hyperextended, a keratotic lesion may develop plantar to the corresponding metatarsal head. Also, with a severe contracture, a callus at the tip of the toe or a nail deformity may develop. A person with diabetes or poor circulation and with hammer toe can suffer from serious problems.

Causes[3][4]

Treatment[3][4]

Clubfoot

Clubfoot also called as congenital talipes equinovarus is a foot deformity in which the foot is twisted inward with the toes pointing down.[5]

Clubfoot

Symptoms[5][6]

Clubfoot is easy to identify. The key features are:

Causes[5][6]

Treatment[5][7]

It is upsetting for every parent to learn that his/her child has any deformity. However, the good news is that clubfoot is treatable. The treatment of clubfoot is proven to be highly successful, which should be started right after the birth, because at this age, the child’s bone, tendon and the joint are flexible, and can easily be manipulated.

The treatments options for clubfoot are:

Conservative or non-surgical treatment

Surgical treatment

Surgical treatment is done in the following cases:

Flatfoot (pes planus)

Flatfoot is a common orthopedic condition in which there is partial or total arch collapse. It is commonly seen in both children and adults. When this deformity occurs in children, although there are several forms of flatfoot, they all share a characteristic "pediatric flatfoot”. Flat feet (pes planus) refer to the loss of medial longitudinal arch of the foot.[8]

Flatfoot

Symptoms[8]

Causes[8]

Treatment[8]

15 to 20% of adults have flexible pes planus which is asymptomatic. Up to 3 years, orthopedic shoes with medial heel wedges and navicular pads are recommended in this group.

Between 3-9 years of age

10-14 years of age group

The asymptomatic case requires molded orthotics worn in a sturdy shoe, physiotherapy.

Surgery for Flatfoot

In severe cases, flatfoot is not helped by more medical management and children need surgery to relieve their symptoms. In almost all cases that require surgery, the child is, at least, 8 years old, and their Achilles' tendon is short. Surgery involves lengthening the short Achilles tendon as well as correcting the flatfoot deformity. The surgeon lengthens the calcaneus (heel bone) using a bone graft inserted on the outer side/edge of the middle of the foot. This procedure is called calcaneal lengthening osteotomy.

Pes cavus (high arch)

Pes cavus (high arch) is a foot deformity characterized by a high arch of the foot that does not flatten with weight bearing. The deformity is located in the forefoot, midfoot, hindfoot, or in a combination of all these sites. Pes cavus or high arch is a common finding in the general population.[9]

High arch

Symptoms[9][10]

Common problems associated with pes cavus include pain under the heads of the metatarsals and heel, frequent lateral ankle sprains and repeated footwear issues. There are a number of symptoms associated with pes cavus such as:

Causes[9]

Pes cavus (high arch) is often due to a neurologic disorder or other medical conditions such as:

Treatment[9]

Non-surgical treatment of pes cavus (high arch) may include one or more of the following options:

Orthotic devices

A custom orthotics (inserts for the shoes) can be beneficial because they provide stability and cushioning to the foot.

Bracing

The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop.

Shoe modifications

High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.

Surgical Management

If non-surgical treatment fails to relieve pain adequately and improve stability, surgery may be needed to reduce pain, increase mobility, and compensate for weakness in the foot.

References

  1. 1 2 Laowattanatham, Navaporn; Chitsakul, Kittipol; Tretriluxana, Suradej; Hansasuta, Cherdpong (Nov 26, 2014). "Smart digital podoscope for foot deformity assessment". Institute of Electrical and Electronics Engineers.
  2. ↑ "Pediatric Orthopedic Diseases".
  3. 1 2 3 4 Coughlin, Michael J. (Aug 1, 2002). "Lesser-Toe Abnormalities". Journal of Bone and Joint Surgery, Volume 84 (8): 1446.
  4. 1 2 3 Angirasa,Arush K.; Augoyard,Marc; Coughlin,Michael J; Fridman,Robert; Ruch,John; (Jun 1, 2011). "Hammer Toe, Mallet Toe, and Claw Toe". Foot & Ankle Specialist , Volume 4 (3): 182 – Jun 1, 2011.
  5. 1 2 3 4 Lloyd‐Roberts, G. (Oct 1, 1964). "Club Foot". Developmental Medicine & Child Neurology, Volume 6 (5).
  6. 1 2 BLECh, EUGENE E (Oct 1, 1993). "Club Foot". Developmental Medicine & Child Neurology , Volume 35 (10) – Oct 1, 1993.
  7. ↑ "Treatment options for clubfoot".
  8. 1 2 3 4 Gross, K. Douglas; Felson, David T.; Niu, Jingbo; Hunter, David J.; Guermazi, Ali; et al. (Jul 1, 2011). "Association of flat feet with knee pain and cartilage damage in older adults". Arthritis Care and Research, Volume 63 (7).
  9. 1 2 3 4 Piazza, S.; Ricci, G.; Caldarazzo Ienco, E.; Carlesi, C.; Volpi, L.; et al. (Dec 1, 2010). "Pes cavus and hereditary neuropathies: when a relationship should be suspected". ournal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology, Volume 11 (4).
  10. ↑ Wicart, P. (Nov 1, 2012). "Cavus foot, from neonates to adolescents". Orthopaedics & Traumatology: Surgery & Research , Volume 98 (7) – Nov 1, 2012.
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