2:04

So some objectives for our talk.

2:07

By the end of today, or this hour,

2:09

hopefully you, as the audience, will be able to,

2:13

one, reiterate the components of the foot.

2:15

It's really helpful if you can separate the foot

2:18

into the hind foot, the mid-foot and the forefoot,

2:21

and tea...

2:22

and treat each component as separate

2:24

structures or separate entities,

2:26

so that you can talk about a one component or one

2:29

compartment, and then the other,

2:31

and it gives you a way of going from one

2:33

portion of the foot to the other

2:35

and organizing information.

2:38

Second, you should be able to distinguish various

2:41

abnormalities including hindfoot varus,

2:43

hindfoot valgus and equines.

2:45

Describe forefoot abnormalities that are

2:48

sometimes associated with these hindfoot

2:49

abnormalities, but not always.

2:52

Differentiate the vertical talus from oblique talus.

2:54

These are two separate entities and somewhat

2:57

related to hindfoot valgus. We'll get into that.

3:00

But they do become very important as we delve further

3:03

into the more intricacies of foot alignment in kids.

3:07

And finally, recognize a condition called skew foot.

3:10

Okay, so if you can do these things,

3:11

and I think you can by the end of this talk,

3:13

you guys should be in great shape.

3:17

There really isn't any reason for you to write

3:19

anything down because everything I'm going

3:22

to talk about today has been published.

3:24

I wrote this along with a couple of colleagues,

3:28

about ten years ago or so,

3:29

in HCR. So if you just Google my name,

3:32

Mahesh Thapa, or just by last name

3:33

and pediatric foot alignment,

3:35

this should be the first thing that comes up.

3:37

And this article also has a bunch of cases at the end

3:41

that you can practice with and do some self assessment.

3:43

So again, just try to pay attention, follow along,

3:47

and we should be fine.

3:48

Okay.

3:49

So before we get started,

3:51

there are certain rules that you have to follow.

3:53

It's like a game. I think of foot alignment as a game.

3:55

If you follow these rules, and sometimes the rules make

3:58

sense, sometimes the rules don't make sense,

3:59

but once you follow these rules,

4:01

you could come to a successful outcome.

4:03

You can end, you can win the game

4:04

if you will. One, anytime you're trying to assess

4:08

foot alignment, it should be done with weight-bearing

4:11

or simulated weight-bearing, because sometimes the kids

4:13

are so small, and they can't walk and things like that,

4:15

so they can't quite weight bear,

4:17

but you can have simulated weight-bearing.

4:19

So, unless you have weight-bearing or

4:21

simulated weight-bearing views,

4:24

the argument is moot.

4:25

You can't really judge anything about alignment.

4:27

So that's criteria number one,

4:29

probably the most important thing you want to know. Two,

4:32

it's important to get orthogonal views of your

4:35

foot, and the most common orthogonal

4:37

views are AP and lateral.

4:39

Just realizing that AP really isn't a true anterior

4:43

posterior view. It's not AP, it's more a dorsi plantar.

4:45

It's looking from top down, but by convention,

4:48

we call that dorsi plantar view AP.

4:50

So AP and lateral are the most common orthogonal

4:54

views or views that are right angle to each other.

4:55

But there are other views,

4:56

but as long as you get two orthogonal

4:59

views, then you are in good shape.

5:01

Three, unlike in adult foot alignment issues, in kids,

5:06

the exact ankle measurements between bones aren't really

5:09

that important. In fact, an over-reliance on these

5:13

values can lead to a wrong diagnosis.

5:15

And I'm going to show an example

5:17

of how that happens sometimes.

5:19

Okay.

5:20

And probably if you don't remember

5:23

anything from the slide,

5:24

you probably want to remember

5:26

this one little assumption, and,

5:29

and you have to...

5:31

everything moves around the talus.

5:34

This is probably the most important thing on this slide.

5:37

I'm going to put Little, Mark's by it.

5:39

Okay.

5:40

And why do I make a such big emphasis about that?

5:43

The talus is the only bone in the foot that has

5:46

no muscular attachments, and that's a profound statement

5:49

because lot of these problems with foot alignment

5:52

are the result of packaging going wrong,

5:56

you know, nerves not acting correctly, muscles

5:59

not acting correctly in response to the nerves,

6:01

too much pulling, too much tugging, too much spasticity,

6:06

but if you have a bone in the foot

6:08

that's immune outside the influence of these factors,

6:13

then it is really an ideal place.

6:16

So you look at a foot and you use the talus

6:20

as the center of your universe.

6:22

What I mean by that is, imagine that bone is exactly

6:27

where it should be in the world of the foot.

6:30

And if there's other bones in the foot that are

6:33

malaligned, it's all relative to the talus.

6:36

So even if the talus looks like it's pointing

6:38

to Never Never Land, realize that

6:40

that is the exact location of foot should be in.

6:43

It's just that every other bone around that talus

6:46

has moved in response to the abnormality.

6:49

Okay?

6:49

So just try to remember that, and I'll bring that

6:51

point home to you as we look at these cases.

6:55

Okay,

6:56

let's separate the hindfoot into

7:00

sections.