Foot deformity
| Foot deformity | |
|---|---|
| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | M20-M21, Q66 |
| ICD-9-CM | 734-735, 755.6 |
| Patient UK | Foot deformity |
| 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]
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]
- Idiopathic
- Improper foot wears (shoes that don’t fit properly)
- Arthritis
- Foot injuries
- Bunions
- Rheumatoid arthritis (RA)
- Genes: you may have inherited a tendency to develop hammertoes because the foot is slightly unstable - such as a flat foot. However, High-arched feet can also get hammertoes.
Treatment[3][4]
- Medicines to relieve pain and swelling
- Sometimes your orthopedic specialist will give cortisone shots to relieve acute pain.
- Your physiotherapist may recommend foot exercises to help restore muscle balance. Splint on the finger can assist in the early stages.
- A podiatrist can also make as an insert to wear in your shoe. This can reduce pain and maintain hammer toe worse.
- There are several surgical techniques used to treat severe hammertoes.
- When the problem is less severe, the surgeon removes a small portion of the affected bone and realigns the joint of the big toe.
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]
Symptoms[5][6]
Clubfoot is easy to identify. The key features are:
- Tightening of the Achilles tendon (heel cord)
- Inward rotation of the front of the foot
- Downward-pointing toes
- Resting on the foot on its outer border
- Rigidity and other changes in the movements of the foot
- Abnormal shape of the foot
Causes[5][6]
- The exact cause of clubfoot is not known (idiopathic)
- In some children, bones may also be abnormal regarding shape, size, or position. There may be a link between maternal smoking during pregnancy.
- Foot abnormally placed in the uterus during pregnancy; it may not grow into a normal shape
- A deformity of the tendons and ligaments in the foot causes an abnormal structure and position of the foot.
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
- Manipulation by mother during feed since the childbirth
- Strapping
- Plaster casts from the 2nd month
- After six weeks of plaster, corrective shoes, corrective night splints should be used to prevent the recurrence.
Surgical treatment
Surgical treatment is done in the following cases:
- If the problem persists after the conservative management.
- In the case of severe deformity.
- In neglected and rigid deformity.
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]
Symptoms[8]
- Heel valgus
- Mid subluxation of the subtalar joint
- Eversion of the calcaneus at the subtalar joint
- Supination of the foot
- Shortened tendon calcaneus
Causes[8]
- Hypertonia of foot muscles
- Excessive fatigue of the foot muscles due to prolonged standing
- Unsuitable footwear
- Trauma (fracture of calcaneus)
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
- Orthopedic shoes for mild cases
- Custom prosthesis for severe cases
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]
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:
- Imbalance/Instability of the foot region
- Pain in the metatarsal heads
- Frequent lateral ankle sprains
- Foot Drop
- Hammertoes
- Pain while standing
- Pain while walking
- Stiffness in the lower leg and foot joints
- Overall foot pain
- Sesamoid Pain
- Claw Toes
Causes[9]
Pes cavus (high arch) is often due to a neurologic disorder or other medical conditions such as:
- Spina bifida
- Charcot-Marie-Tooth disease
- Cerebral palsy
- Muscular dystrophy
- Polio
- Stroke
- In other cases of pes cavus, the high arch may represent an inherited structural abnormality.
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
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