Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Juvenile HAV

Discussion in 'Pediatrics' started by mcnallyk, Jan 10, 2011.

Tags:
  1. mcnallyk

    mcnallyk Welcome New Poster


    Members do not see these Ads. Sign Up.
    I was wondering what the current thought was regarding treatment of juvenile HAV? what are your views?
     
  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with juvenile HAV
     
  3. rboone

    rboone Member

    I am 24 now and I have the condition on my left foot only and would like some feedback about this also.
     
  4. footfan

    footfan Active Member

    OK guys, unfortunatly the best management for juvanile (up to 21 years of age!!) hallaux valgus is uncertain. Foot orthoses have been found by Dr. Kilmartin & co. not slow the progression.
    Other non-surgical measures you might try are: accomodative well fitting footwear, mobilizing the first metatarsophalangeal joint and the widely debated splinting. These are best for mild cases or to try and slow progression and addressing abnormal foot biomechanics is by far the best approach. Unfortunatly you will have to be realistic about conserative and surgical treatments and what can be acheived.

    Surgically there are over 100 different techniques that can be used, but the reoccurence rate is approx. 10%.


    I have personally seen case studies published with daily manipulation, stretching and strengthening in mid 20's age range that have shown good results , one was recently published in podiatry now ill bulldose my house and try to find it .

    Hope this helps :drinks
     
  5. footfan

    footfan Active Member

    ok im covered in dust but, Jedynak., T. (2009) Treating Hallaux abducto valgus conservatively through foot mobilisation techniques and exercise therapy- a case study, Podiatry Now, Volume 12:10, Pages 12-15.

    Outcomes: improvement in both foot pain and foot function at 3 and 6 months follow up. Hallaux abductus angle reduced by 20 degrees, 1st/2nd intermetatarsal angle reduced by 6 degrees and talus: foot midline angle reduced by 4 degrees. All by Radiographic measurements.

    Seems very promising.
     
  6. drsarbes

    drsarbes Well-Known Member

    "1st/2nd intermetatarsal angle reduced by 6 degrees....."

    I doubt this. Have the surgery and be done with it.

    Steve
     
  7. footfan

    footfan Active Member

    I am only commenting on what ive read in this case study. Moderators remove if need be.

    Its attached and the figures are in the bottom table.
     

    Attached Files:

    • Scan.jpg
      Scan.jpg
      File size:
      481.1 KB
      Views:
      115
  8. Like Steve said, bunion surgery is very predictable in the hands of a well-trained and experienced podiatric surgeon. Find a good surgeon and get the surgery done.
     
  9. drsarbes

    drsarbes Well-Known Member

    Hi Jon:

    I appreciate the results being quoted from a study, but again, there are studies and there are studies.

    Unless we know who did the study and who paid for it, what controls were used, was it duplicated elsewhere, etc etc etc...... common sense tells me that it is highly improbable that any manipulation decreased an IM angle by 6 degrees.
    If it were that easy I'd be out of business.
    Steve
     
  10. He who wrote such study will be having similar discussions over a beer or 10 with me in April, Ted now some of the discussions are with notice. :drinks am looking forward to it if the volcaneos allow.
     
  11. footfan

    footfan Active Member

    Michael did you discuss the case study with the author??

    Regards

    FF
     
  12. No we got talking about something else in fact. Forgot all about it.
     
  13. footfan

    footfan Active Member

    oh well. Is the author on PA?? Maybe get him to start a thread on it ??

    FF
     
  14. And very Unpredictable in the hands of other surgeons.

    And that's the real trick isn't it. How does one know the quality of one's surgeon beforehand?

    I've seen some fantastic surgical outcomes on HAV with some very happy patients. But I've also seen more than a few end up with extremely poor function, or worse, irrevocable damage.

    My advice for patients considering surgery is that it is always going to be a gamble. Whether you fold or raise depends on the cards you're holding. In other words, if you can cope with it, cope with it. If you can't, take a punt.
    With respect, I find little value in statistics like these. Firstly, it depends on what you mean by recurrence. Recurrence of what exactly? I've seen patients with terrible post op ROM and severely impaired windlass function... but good IM angles. Not a recurrence, but certainly not a good outcome. Secondly, it depends on the surgeon who's outcomes are being measured. Your surgeon may have an RC rate of 5%. Or indeed 15%. Thirdly, there is no timescale. Recurrence after 6 months, 6 years or 20 years? Lastly, such figures depend heavily on how the outcomes are measured locally. There are ways to massage the statistics...
     
  15. footfan

    footfan Active Member

    Robert,

    Ive said it on other threads and ill say it again , too much expectation is built by the media regarding surgery and is embedded in patients heads, they now see it as if its a part being replaced in thier car, you turn up a guy pops the bonet , unscrews a few bolts , screws something in and hey presto all sorted. I honestly do not beleive ANY surgery is anything other than salvation, but this is just my opinion, hence my use of PUBLISHED statistics.

    Do you treat deviations from biomechanical "ideals" in paeds patients that have or is progressing HAV??

    FF
     
  16. Agreed.

    But I dispise misleading statistics. Where is the 10% figure from out of interest.
    No.

    If a child has a massively prominent talus and a pes pancake foot, I'll treat an ineffective deltoid ligament and perhaps seek to reduce the inversion moment on the MTJ by reducing the residual supination moment demanded of the deltoid ligament and increasing the external rearfoot inversion moment. But that's not the same as treating deviations from the ideals because I don't know what those Ideals are.
     
  17. footfan

    footfan Active Member

    Lol its from http://www.ncbi.nlm.nih.gov/pubmed/7249456 via http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405780/ via Angela Evans 2011 Paediatrics. =S

    [/QUOTE]I don't know what those Ideals are[/QUOTE]

    I know I asked the impossible because noone knows and anyone who thinks they do know , know little because they dont know what they dont know, which is all I know.

    But thats not going to satisfy the 13 y/o patient who just wants to look like shes from the only way is essex in rediculous shoes but hopefully VB has changed a few opinions http://news.sky.com/skynews/Home/Sh...e-Sore-Looking-Bunion/Article/201002115540382 Chukkled when i saw Trevors name pop up.

    It is good at highlighting foot problems and as daft as it sounds we will get more referrals if she does have surgery because it will be publicised to a demographic who have no idea what a chiropodist/podiatrist/whatever the hell the SoCP decide to call us does, that we do exist - which is a very good thing.

    Robert would like your opinions on this 'Happy Feet' Educational Campaign http://www.circlepodiatry.co.uk/services.htm you do alot of paeds and this isnt a million miles away from where your based.

    FF
     
  18. drsarbes

    drsarbes Well-Known Member

    "But I dispise misleading statistics. Where is the 10% figure from out of interest...."

    well, 26.4% of all statistics are made up on the spot.

    Steve
     
  19. I heard it was 26.7%.;)

    Anything which improves the public knowledge of Children's foot problems is a good thing. I do paeds almost exclusively and the people referred who don't need to be are almost as frustrating as the people who aren't when they should be. Its a good idea! I do quite a bit of work with a few local independent shoe shops in a similar vein. The "lady in the shoe shop says" is a force to be reckoned with!
     
Loading...

Share This Page