7 year old male, born with bilateral talipes equinovarus. Following birth casting was performed from 5 days old, dennis browne bar, and surgery at 6 months of age. All initial treatment successful.
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However, child has presented with recent severs type pain, occasionally back pain, and mother is also concerned the club foot maybe reverting back.
The child has been undergoing physiotherapy - stretching exercises etc.
On examination:
- Significant reduction AJ DF - flexed and extended, tendon taut - muscle belly soft
- STJ restricted
- MTJ increased inv
- Met adductus - styloid prominant right more than left
- talar buldge right more than left, corrected on NCSP
- calf muscle atrophy
- Calc pos vertical to slight evr
- tib pos vertical
- forefoot to rearfoot relatively parallel
- Arch profile mildly cavus
- Supination resistance - relatively low resistance to supination
- Jacks test negative
- single leg stance - lateral instability, flexor substitution.
My opinion is the foot following all previous treatment, has now aquired a z shape or skew foot structure.
Having had little experience treating the skew foot or post talipes patients, could anyone offer some advice or direction with the treatment of this patient?
Also is it possible for the club foot to re-present, following successful surgical, casting and splinting techniques.
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