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- Pes Planus foot, rocker bottom, flexed toes
- Hindfoot - in equinus with calcaneum point down
- Midfoot - dorsiflexed and abducted with dorsal lateral skin crease
- Expect to find talar head prominent medially
- No callus/ ulcerations
- Examine further for correctability and complications of deformity
- Assess spine for myelodysplasia and other joints for athrogryposis
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- “It is a teratalogic disorder with the navicular dorsally dislocated on the talus which is irreducible”
- Irreducible dorsal dislocation of navicular on talus ➔ rigid flatfoot
- A teratologic disorder (vs packaging disorder that is OVT)
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- Idiopathic vs syndromic
- aw myelodysplasia [Look at spine] , arthrogryposis [look at other joints], CP, SMA
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- Gene is HOXD10 gene
- a/w Arthrogryposis, Spinal dysraphism, cerebral palsy, SMA
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- It is a less severe form of CVT
- In OVT, the talus is aligned when foot is plantar flexed (A and B and C).
- But CVT is misaligned in both plantar or dorsiflexion (D)
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- By the position of the calcaneum. In CVT, calcaneus is point down (equinus) while in calcaneovalgus, it is point up
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- Talus being vertical. Calcaneus is in equinus
- THis is determined by comparing the axis of the talus and the 1st MT-cuneiform exis
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- Dobb’s serial casting ("reverse ponsetti")
- Goal is to bring the foot that is “out and up” to “down and in”
- 4-6 week duration of weekly Toe to groin cast, goal is to maximum plantar flexion and inversion (club foot position)
- Using the right foot as a reference
- The Right thumb is placed at the medial aspect of the talar neck as the fulcrum, pushing it dorsally and laterally
- Like ponseti, the fulcrum is at the talus but unlike ponseti, using the direction of manipulation is that the navicular is plantar flexed and translated medial
- Left hand manipulate the navicular into plantar flexion and adduction
- Cast until Navicular is reduced (based on 1st MT cuneiform axis ➔ percutaneous talonavicular pinning + TA tenotomy
- [Most] Surgical soft tissue procedures if unsuccessful at 1 year old
- Peroneus Brevis (contracted due to lateral subluxation)fractionated if adduction < 10
- EHL, EDC fractionation (chronic contractures) if plantar flexion < 25
- TA lengthening (chronic equinus)
- with Talonavicular pinning
- Long leg cast x 5/52
- Followed by Foot abduction orthosis - Brace as per ponseti method (except that brace is neutral rather than ER)
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- Talectomy
- Triple arthrodesis (TN, CC, ST)