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X-Ray Musculoskeletal Conditions of the Foot and Ankle part 1

Updated: Jan 15, 2022

Musculoskeletal Conditions:

  1. Congenital

  2. Acquired

Congenital: failure of the foot and ankle to develop in the usual way during pregnancy, so the abnormality exists when we are born

  • Either the “building blocks” (BONES) are wrong, or,

  • The SOFT TISSUES of the foot and ankle (muscles, tendons and ligaments) are altered in form or

  • function, so that the foot doesn’t take up its normal configuration

Congenital abnormalities – bones

  1. Absent bones - rare (need to know how many bones)

  2. Bones in an abnormal position (need to know their normal relationships)

  3. Fused bones (need to know how many bone)

How many bones?

1- Absent bones

Foot Anatomy

  • Hind-foot = 2 Bones – Calcaneus and Talus

  • Mid-Foot = 5 Bones – Navicular, Cuboid and 3 Cuneiforms

  • Fore-foot = 5 Metatarsals, 2 phalanges 1st toe, 3 phalanges 2nd5th toes Foot

2- Bones in an abnormal position – VERTICAL TALUS

Vertical Talus

  • Rocker bottom foot

  • Associated with a wide variety of neuromuscular abnormalities

  • Rare

  • Relatively little functional abnormality

3-Fused bones

Tarsal Coalitions

  • 1st described by Buffon in 1796

  • Rare – true incidence unknown because often asymptomatic

  • Usually Calcaneus fused to either Talus or Navicular

  • Often present with non-specific mid-foot or hind-foot symptoms

  • Usually don’t need surgery

Congenital abnormalities – soft tissues

Abnormal configuration of the foot

Talipes Equino - Varus

  • 1:1,000 births

  • Affects both feet in 50%

  • Idiopathic: no identifiable cause, but genetics plays a part as there is often a strong family history. More common in boys.

  • Neuromuscular: specific problem with foot’s nerve or muscle control (e.g. spina bifida) causing foot deformity through imbalance

  • Syndromic: foot deformity related to more widespread joint, cardiac and pulmonary abnormalities – often genetic problem

  • Postural: late stages of pregnancy – foot squashed in abnormal position – feet improve spontaneously or with short course of physiotherapy – usually completely normal by about 3 months of age

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