Differentials
Metatarsus adductus
SIGNS / SYMPTOMS
While the forefoot is adducted, the heel is neutral or slight valgus without equinus.
INVESTIGATIONS
Usually not needed, but if underlying anomalies are suspected or when assessing an older child, x-rays can be obtained. These demonstrate a normal hindfoot and medial deviation of the metatarsals at the tarsometatarsal joint.
Skewfoot
SIGNS / SYMPTOMS
Forefoot adduction with the hindfoot in valgus. No equinus deformity.
INVESTIGATIONS
Standing x-rays demonstrate an increased angle formed by lines drawn through the calcaneus and talus on anteroposterior views. The navicular is displaced laterally instead of medially on clubfoot x-rays.
Calcaneovalgus or talipes calcaneal valgus
SIGNS / SYMPTOMS
The foot is in maximum dorsiflexion at birth (the foot is in contact with the anterior tibia.) The heel is valgus. The deformity can usually be brought to a neutral position.
INVESTIGATIONS
X-rays are not usually necessary as long as the examination can differentiate this from a vertical talus.
Vertical talus
SIGNS / SYMPTOMS
The foot has the classic appearance of a 'Persian slipper' or rocker-bottom deformity. The heel cord is in fixed equinus as in clubfoot, but the heel in vertical talus is in valgus with the forefoot dorsiflexed at the midtarsal joints.
INVESTIGATIONS
X-rays to include a maximum plantar flexion lateral view demonstrate a vertically oriented talus with no reduction of the dorsally dislocated forefoot on the talus during plantar flexion.
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