Disorders of the foot presenting at the time of birth can gradually develop into far more serious foot conditions if left untreated, inevitably affecting the optimal functioning of the feet at a later stage in life.
This makes the early identification and management of congenital foot abnormalities such as talipes calcaneovalgus, metatarsus adductus and talipes equinovarus essential to protect the child from limitations in mobility and daily activities.
It is equally important to gain a thorough understanding of disorders such as arthrogryposis or multiple joint contractures which lead to the formation of the above mentioned foot abnormalities.
Reggie Hamdy and Noémi Dahan-Oliel, from the Shriners Hospital for Children, have written extensively about arthrogryposis in the book, ‘Pediatric Lower Limb Deformities’.
The authors mention that the most common form of arthrogryposis is amyoplasia which is characterised by no muscle growth; among the lower limbs, the foot is most commonly affected by amyoplasia, followed by knee deformities and hip deformities.
The feet are observed to have severe equinovarus contractures that restrict function, requiring the child to undergo physical and occupational therapy which can extend well into their adolescent years.
As discussed by Bamshad et al. in their review, the goals of initial treatment for amyoplasia are to facilitate mobilisation of joints, to improve position and function by applying splints and to allow for the development of adaptive patterns of walking.
Although multiple orthoses may be required throughout the child’s development, an orthotic intervention in the form of customised foot orthotics such as MASS4D® may help in controlling motion and treating secondary effects, having a favourable impact on the equinus foot.
With an improvement in the foot/ankle range of motion, there is a reduction in the load placed on the soft tissue supportive structures around the foot/ankle complex, helping diminish compensatory movements of the lower limbs and providing a stable base of support for resistance of body sway.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.