Challenge of the Week / Foot & Ankle / 11.01.19

A 12-month-old child is referred for short stature. The child has a history of frequent respiratory tract infections. Examination reveals a short neck, coarse facies, and claw hands. Radiographs indicate flaring of the ribs and medial clavicle, anterior vertebral wedging, and odontoid hypoplasia. Which of the following is most likely to limit this child’s mobility?
  • Hard sole shoe to shield the midfoot
  • A hard sole shoe will not accommodate this deformity and may be associated with the recurrence of ulcers.

  • Transmetatarsal amputation
  • Transmetatarsal amputation will not address the more proximal deformity and leads to unnecessary functional limitations.

  • In situ midfoot fusion with intramedullary screws
  • In situ fusion may prevent further progression but will not address the deformity that led to the prior ulcers.

  • Medial/plantar closing wedge osteotomy through the midfoot
  • This osteotomy will address the deformity that has developed through the midfoot, leading to a plantigrade braceable foot and possibly avoiding recurrent ulceration. Another possible operative intervention to consider would be a plantar ostectomy. However, this does not accurately correct the underlying angular deformity.

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