Subluxed Hallux ?? 15month old

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Hi All

Recently saw a very active, otherwise completely healthy (and happy) 15 month old boy, who presented with a +-20 degree adducted hallux of the right foot.

Mom says its been since birth. Paediatrician told her that it would correct when he began walking - but it has worsened. The boy has scrapes and scratches on his right shoulder, arm, face and leg due to falling constantly over his toe.

Examination was largely (besides this hallux) unremarkeable.
He was a natural delivery (9 days late) without any complications.
All joints in BOTH feet were within normal range-of-motion limits, save for the right 1st MPJ which was limited in dorsiflexion/ plantarflexion.
Jack test showed good medial longitudinal arches, bilaterally.
Usual genu varum with normal tibial varum present for this age group.
No neurological deficit's, preipherally or globaly.
Perfectly average development so far.
The 1st metatarsal seems somewhat adducted, possibly to do with the hallux adduction. There was no hallux varus or valgus present. The other digits appeared relatively normal.

I have requested x-rays and advised on wearing shoes to keep the hallux in line to minimise falling in the mean time.

Whilst awaiting the xrays, I was thinking of a Gait plate to induce abduction?

When I follow him up, I will take pics and post them.

Any thoughts appreciated.

Thanks

Brandon

 

I would be reluctant to use a gait plate, as that will attempt to evert the whole foot, when all you are wanting is to reduce the I-M angle????