By Dr. Vincent S Mosca MD
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Additional resources for Principles and Management of Pediatric Foot and Ankle Deformities and Malformations
RADIOGRAPHS AND OTHER IMAGING The foot-CORA (center of rotation of angulation) method should be used pre-, intra-, and postoperatively for the most objective evaluation of foot deformities and malformations. Assessment Principle #17 All radiographs for the assessment of foot deformities should be btained in weight-bearing, or simulated weight-bearing if the former is not possible because of extreme youth or the child’s inability to stand. This is the radiographic version of Assessment Principle #14.
Loss of flexibility of the hindfoot, which is assessed by the Coleman block test, eventually follows (Figure 3-3). I have found that the block test, as described by Coleman, is uncomfortable and awkward to perform and, therefore, unreliable. With the entire lateral column of the foot on the block, it is tempting for the child to balance the foot on the block, rather than allowing the forefoot to pronate off the block. Price and Mubarak have independently proposed alternate methods for the clinical assessment of hindfoot flexibility in a cavovarus foot.
The natural history for the development of pain in congenital oblique talus (COT) has not been documented, because the very definition of the deformity is unknown. Therefore, the natural history must be assumed based on its position in the continuum of valgus deformity of the hindfoot (Figure 2-15). C Figure 2-12. A. Release of the medial soft tissues in a cavovarus foot will allow the inverted subtalar joint to evert. B. , a flatfoot. It will not invert. C. Release of the lateral soft tissues in a flatfoot will have no effect on the valgus/everted deformity.