- See:
Congential Clubfoot Menu:
- Clinical Anatomy:
- affected limb may be shortened, calf muscle is atrophic, and foot is short compared to opposite side;
- medial rotation of tibia;
-
joints:
- ankle and subtalar joints are in fixed equinus;
- posterior displacement of lateral malleolus: (assess with patient prone and knee flexed to 90 degrees)
- hindfoot:
- heel is inverted (varus)
- talus lies in a position of equinus, medial rotation (in the ankle mortise);
- its head is palpable at
sinus tarsi;
- pronounced medial angulation of head and neck of talus;
- calcaneus is in equinus, varus, and is rotated internally;
- w/ more severe deformity, calcaneus may be difficult to palpate (because of the underlying fatty tissue);
- midfoot:
- no midtarsal mobility;
- medial or transverse midfoot crease (indicates more severe deformity)
- navicular displaced medially, and may abut the medial malleolus;
- cuboid is medially displaced in relation to the long axis of the calcaneus (but to lesser degree than the navicular);
- os calcis fixed to fibula
- curved lateral foot border
- forefoot:
- forefoot and midfoot are inverted and adducted
- forefoot cavus w/ depressed 1st metatarsal;
- fixed forefoot supination relative to the hindfoot (forefoot varus);
-
tendons and ligament contractures:
- contracture of Achilles
-
tibialis posterior;
-
plantar aponeurosis;
-
abductor hallucis;
-
FDB (causing a cavus deformity of foot);
- long toe flexor tendons;
-
ext. digitorum longus
-
tibialis anterior
-
extensor hallucis longus
- contractures of spring, bifurcate, deltoid, calcaneofibular, talofibular ligaments;
- calcaneonavicular (spring ligament): runs from sustenaculum tali to plantarmedial aspect of navicular;
- Master Knot of Henry:
- fibrous slip that envelops the FHL and FDL tendons;
- binds the plantar medial surface of the navicular;
-
vascular exam:
- note that the dorsalis pedis artery is frequently not present in club foot and therfore special care
must be taken to avoid injury to the posterior tibial artery during a posteromedial release;
- references:
- Clubfoot: its pathological anatomy.
CB Howard and MKD Benson.
JPO Vol 13. 1993 p 654-659.
Clubfoot References
