7 yr old met adductus advice

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Hi guys I had a patient in today that I'd be keen to get some ideas on treatment

7yr old male, beightons score 7 mainly hips, wrists, knees and feet. normal birth and milestone history, walked at 16mnths middle of 3 children older brother had flexible met adductus. I saw the pt 4years ago originally for flexible met adductus and referred on to orthopaedics as mum was insistant on exploring all avenues. Orthopaedics gave advice on development and discharged.

Pt today is still complaining of flexible met adductus, he is getting rubbing and pain to both medial condyles of 1st IPJ with some soft tissue swelling evident, Both joints are retracted almost like a trigger toe. There is obvious rubbing from the footwear - which is very good and supportive. Due to his hypermobility his gait is a little clumsey with a huge amount of movement (med -lat) at hips hyperextension of knees heel strike and late midstance, there is a huge amount of forefoot splaying, with minimal frontal plane stj motion in stance.

Any ideas if to treat /not treat or reduce the rubbing to the 1st ipj areas??

thanks all

Bartypb

 

Barty some reading

The Long-Term Functional and Radiographic Outcomes of Untreated and Non-Operatively Treated Metatarsus Adductus*

as discussed a little here

Prefab orthotic with gait plate

but more here

Metadductus in a toddler

 

Sounds very unusual and interesting. Because it's so unusual, it is hard to describe and even harder to imagine from a brief written description. Several pictures, weigthbearing and non weightbearing would really help in understanding what this kid needs. I'm not sure what you mean by condyle of 1st mpj.

Eric

 

Sorry Eric by the medial condyle I mean the dorso medial aspect of the base of the distal phallanx at the IPJ, the joint is a little retracted. It is a little difficult to provide pictures as this is an NHS patient and there are all sorts consent issues, I will ask the pt's mother at the next appt if I can photograph and post as an aid to treatment.

thanks

Bartypb

 

At this point l would be looking at custom footwear to at least make your client comfortable and more stable.

l would suggest based on the clients l see, that at the propulsive phase of gait that the foot has it worst ADducted moment and the most painful, maybe a mild rocker sole to reduce the force at the met. at this point, coupled with a lateral sole flare heel to midfoot for added stability

 

In the early days of my business, many clients with similar conditions, with ages from 3 to exceeding seven, were referred for corrective footwear. Straight last shoes +/- splinting to be worn at night at night was prescribed. There is only anecdotal evidence for positive outcomes.

This kind of prescription is now rare as early intervention with foot orthoses is applied. However, if all esle fails, sometimes one is relegated to "an oldie but a goodie" approach.

I hope it helps