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Pediatric Foot Disorders: Developmental Deformities
Introduction
The developmental deformities discussed in this chapter are flexible flatfoot, cavus foot, adolescent hallux valgus, Kohler’s disease, Freiberg’s infraction, Sever’s disease, congenital curly toes, overriding fifth toe, and ingrown toenails.
Flexible FlatfootThere is a general perception on the part of the public that individuals who lack a longitudinal arch of the foot are abnormal. Several studies suggest that flat feet are a common finding in a significant number of asymptomatic, otherwise normal individuals. Thus, it can be stated that while the term flexible flat foot describes the subject’s foot, it cannot be stated that this type of foot is abnormal. (Staheli 1987)
Cavus Foot In the cavus foot, there is a fixed equinus deformity of the forefoot on the hindfoot (Figure 28).
Adolescent Hallux ValgusDeviation of the great toe toward the lateral border of the foot occurring at the MP joint is known as hallux valgus (Figure 32). It is also termed a bunion. This deformity occurs most commonly in adults, but is not infrequent in adolescents.
Kohler’s DiseaseIn 1908, Kohler described a foot disorder in preteen children that affected the tarsal navicular. (Kohler 1908) The radiographic features of the navicular in patients with this disorder are consistent with avascular necrosis.
Freiberg’s Infraction In 1914, Freiberg described a form of metatarsalgia in adolescents that is associated with radiographic features of avascular necrosis of a metatarsal head. (Freiberg 1926)
Sever’s DiseaseIn 1912, Sever described a type of heel pain in children and adolescents characterized by tenderness localized to the calcaneal apophysis. (Sever 1912)
Congenital Curly ToesIn this condition, the affected toe assumes a position under the adjacent medial toe due to flexion deformity at the PIP joint, combined with supination of the affected toe.
Overriding Fifth ToeIn this condition, the fifth toe assumes a position on top of the fourth toe.
Ingrown Toe NailsIn this condition, the distal corner of the nail digs into the nail groove, which causes pain and inflammation.
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