Kohler's Disease In the Foot

Kohler's Disease is a rare bone disorder of the foot found in children between the ages of 6 and 9, affecting boys more than girls. It was first described in 1908 by Alban Kohler a German radiologist.
It is caused when the navicular bone temporarily loses its blood supply and as a result, the tissue in the bone dies and the bone collapses.
Symptoms include pain and swelling in the middle of the foot and usually a limp. Patients who limp tend to put increased weight on the lateral side of their foot. They may also experience tenderness over the navicular and pain over the apex.
In February 2010 the Journal of the American Medical Association reported that Egyptian boy king Tutankhamun may have died from complications of the disease along with malaria.
Your podiatrist will take an X-ray of the affected foot to diagnose the disease. The affected foot will have a sclerotic and flattened navicular bone.
When treated, this disease has no long term affects, but rarely it can return in adults. Treatment includes resting the affected foot, taking pain relievers, and avoiding putting pressure on the foot. In severe cases, the patient wears a cast, worn between 6 and 8 weeks. After the cast is removed, arch supports are worn for about 6 months. Children may benefit from moderate exercise and physical therapy. Children who follow the prescribed treatment will heal quickly. Kohler's Disease may persist for some time, but most cases are resolved within two years.
If your child has Kohler's Disease, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Adult Cavovarus Foot

Adult cavovarus foot is the result of an imbalance of muscle forces, usually from motor sensory neuropathies. It is seldom seen at birth, but the deformity becomes apparent as the child, or the deformity grows. Other causes include cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot.
In this foot deformity, the strong peroneus longus and tibialis posterior muscles cause the hindfoot varus and forefoot varus (pronated) position. Hindfoot varus causes overload of the border of the foot, which results in ankle instability, stress fractures, and peroneal tendonitis. In overloaded joints, degenerative arthritis can develop. Claw toes may also be a symptom of this deformity.
Your podiatrist will do a gait examination, which allows for the planning of tendon transfers to correct the stance and swing-phrase deficits. They will also inspect the forefoot and hindfoot to determine the need for soft-tissue release and osteotomy. The Coleman block test assesses the cause of hindfoot varus.
Oddly enough, prolonged use of orthotics and supportive shoes can result in muscle imbalance, creating the deformity and causing irreversible damage to the tendons and joints. Your doctor will have to rebalance the tendons to avoid deterioration of the foot. Muscle imbalance can be rectified by tendon transfer, corrective osteotomy, and fusion.
If you have cavovarus foot, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Hitchhiker's Toe

"Hit the road, Jack, and don't you come back no more no more..."
Hitchhikers are often seen on major state roads, giving the old thumbs up gesture, an indication that they're looking for a ride. But did you ever see a hitchhiker giving the old big toe up gesture???
Hitchhiker's toe resembles the thumb of a hitchhiker, due to the hyperextension of the extensor hallucis longus muscle. This involuntary position is also called striated toe.

A patient often develops the hyperextension of hitchhiker's toe from spasticity,  which is caused by brain injuries, like a stroke, neurological condition, or spinal cord injury. Some toes are painful because of an altered gait or shoe fitting issues. This issue is also commonly found with other neurological conditions; drop foot and equino varus deformity are also common with hitchhiker's toe.
Symptoms include the first toe pulling up instead of lying down as it should, pain due to pulling on the muscle, and pain or callusing on the toe where it hits the shoe. The patient should look out for when the foot moves into the varus position, the aftereffects of a stroke or other neurological condition, or recovery from spine surgery or injury.
Causes of this deformity include stroke, cerebral palsy, physical trauma, such as a spinal cord injury, and
other neurological disorders.
The goal of treatment is to restore balance and support in the foot, since the big toe bears a great deal of our body's weight. An lower and thinner orthotic may be created to support the longitudinal and metatarsal, and bracing may be necessary to relax the toe. The patient should avoid flip-flops, except those approved by the American Podiatric Medical Association, high heels, and going barefoot. Physical therapy may be prescribed to regain strength in the toe.
If you have hitchhiker's toe, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Metatarsus Adductus in Children

Metatarsus adductus, or metatarsus varus, is a common foot deformity present at birth that causes the front half of the foot to turn inward. This condition can be flexible, meaning the foot can be straightened by hand, or non-flexible, meaning the foot cannot be straightened by hand.

The cause of metatarsus adductus is not known and occurs in one out of every 1,000 or 2,000 live births, affecting boys and girls evenly. Causal factors include a family history of metatarsus adductus, the position of the baby in the uterus, especially with breech babies, and the sleeping position of the baby (babies sleeping on their stomach sometimes increase the tendency to turn their feet outward).
Babies born with metatarsus adductus may be at an increased risk of having a related hip condition called developmental dysplasia of the hip (DDH). DDH is when the hip joint slips in and out of its socket, because the socket is too shallow to keep the joint intact.
Diagnosis is through a physical examination, where the doctor will ask if any other family members have metatarsus adductus. X-rays are taken in cases of non-flexible metatarsus adductus.
Infants with metatarsus adductus have high arches and the big toe has a wide separation from the second toe and deviates inward. Flexible metatarsus adductus is diagnosed when the heel and forefoot can be aligned with each other with gentle pressure on the forefoot while holding the heel steady. If the heel is difficult to align with the heel, it is considered non-flexible, or stiff foot.
Treatment for metatarsus adductus is based on:

• Your child's age, overall health, and medical history
• Extent of the deformity
• Your child's tolerance for certain medications, procedures, or therapies
• Expectations of the course of treatment
• Your opinion or preference

The goal of treatment is to straighten the position of the forefoot and heel. There are various options, including:

• Observation for those with flexible forefoot
• Stretching or passive manipulation exercises
• Casts
• Surgery

Metatarsus adductus may suddenly resolve itself without any medical intervention.
Your doctor will instruct you in passive manipulation exercises on their feet while diaper changing and will recommend changing their sleeping position.
In rare cases where stretching and manipulation exercises do not work, long leg casts will be applied. Casts are used to stretch the soft tissues of the forefoot and are changed every one to two weeks. If the foot responds to casting, straight cast shoes will be prescribed to hold the forefoot in place. This cast is made without a curve in the bottom of the foot. Infants with very severe metatarsus adductus will require surgery to release the forefoot joints.
With treatment, this condition can be resolved and the child can live without pain in their foot.
If your child is born with metatarsus adductus and has foot deformities, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Rocker Bottom Feet

Congenital vertical talus, also known as rocker bottom foot, is a rare deformity of the foot which is diagnosed at birth. It is one of the causes of flatfoot in the newborn. One or both feet may be affected. It is not painful for the infant, but if left untreated, it can lead to serious disability and discomfort.

The talus is a small bone that sits between the heel bone and two bones of the lower leg. The tibia and fibula sit on top and around the sides of the talus to form the ankle joint. The talus is an important connector between the foot and leg, helping transfer weight across the ankle joint.
In congenital vertical talus, the talus has formed in the wrong position and the other foot bones to the front of the talus has shifted on top of it. Because of this, the front of the foot points up and may even rest against the front of the shin. The bottom of the foot is stiff and has no arch. Usually it curves out, hence the rocker bottom phrase.
Vertical talus is sometimes confused with newborn flatfoot, or even as clubfoot. The exact cause of this deformity is not known, but many cases of vertical talus are associated with a neuromuscular disease or other disorder, such as arthrogryposis, spina bifida, neurofibromatosis, and numerous syndromes. Your doctor may perform tests to see if your infant has any of these conditions.
Treatment for vertical talus centers on providing your child with a functional, stable, and pain-free foot. It is crucial to have this condition treated early, as your child will learn to walk on an abnormal foot and painful skin problems will develop.
Nonsurgical treatment includes a series of stretching and casting designed to increase the flexibility of the foot and even sometimes correct the deformity. Some doctors will also prescribe continued physical therapy exercises to improve flexibility.
Surgical treatment, however, is the most common treatment. When nonsurgical treatment has failed, your doctor will recommend surgery between the ages of nine and 12 months. Surgery is designed to correct the aspects that cause the deformity, like problems with the foot bones, ligaments, and tendons that support the bones. The surgeon will put the bones in the correct position and apply pins to keep them in place. Tendons and ligaments may have to be shortened. A cast will be placed on your child's foot, and they may have to spend the night in the hospital. After four to six weeks, the cast will be removed and a special brace or shoe may be worn to prevent the deformity from returning.
With treatment, your child's foot should make a full recovery, allowing them to run and play without pain and wear normal shoes. Your doctor may recommend repeat visits throughout the years to monitor the development of your child's foot.
If your child is born with rocker bottom foot and has foot deformities, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Foot Deformity in Infants

Calcaneovalgus foot is also known as flexible flatfoot in infants and young children. In infants this foot disorder is seen with the foot abducted (turned) and the ankle severely dorsiflexied (twisted). Upon birth the foot looks like it is plastered against the front of the leg. A mild form of calcaneovalgus foot may be seen in 30% of infants, but the more severe form may be present in 1/1000 infants.

Calcaneovalgus foot is a common foot disorder which is a result of intra uterine positioning, and muscle imbalancing, which happens because of weakness of plantarflexors.
Calcaneus indicates that the heel is downward, and the ankle is flexed upward. Valgus refers to the heel turned outward. Calcaneovalgus feet are often called "packaging problems" because the structures were normally formed, but were deformed in the uterus because of crowding. It is commonly seen in first-born children and females.
Diagnosis is made by physical exam. The feet have a classic appearance with the feet bent upward, and the heel bone should be palpable to the heel pad in a twisted position. There should be good ankle motion, but may be limited by tight anterior structures. There should also be good flexibility in the hindfoot and forefoot. It is important to verify the flexibility of the foot and ankle.
Treatment can often be very simple. Gentle stretching and massage will help mobility and appearance. Within one to two months, the feet will have improved. In serious cases casting, followed by stretching exercises and an AFO splint for additional months may be necessary.
Most infants have a full recovery with recommended treatment. Rarely there is an external rotation alignment issue to the legs as the child begins to walk, but this typically corrects itself over time.
If your child is born with calcaneovalgus foot and has foot deformities, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Amniotic Band Syndrome and the Feet

Amniotic band syndrome is a congenital disorder caused by fetal limbs or digits getting caught in fibrous amniotic bands while in utero. Amniotic banding happens in every 1 in 1,200 live births and is likely responsible for 178 in 10,000 miscarriages. About 50% of cases also have other congenital deformities, including cleft lip, cleft palate, and clubfoot. It is considered an accidental occurrence and does not appear to be genetic or hereditary.
Constriction of appendages by amniotic bands may result in:

1. Constriction rings around the digits, arms, and legs.
2. Swelling of the extremities distal to the point of constriction.
3. Amputation of digits, arms, and legs.

Many who have ABS will have clubfoot, which occurs in roughly 31.5% of cases. Disfigured feet in general are a common deformity in this disorder.
Some researchers believe that ABS is caused by early amniotic rupture, which leads to the formation of fibrous strands that entangle limbs and appendages. Treatment occurs after birth and involves plastic and reconstructive surgery, ranging from the simple to the complex. Prognosis depends on the location of the amniotic bands. Bands that are wrapped around fingers, toes, feet, or hands can result in syndactyly or amputations of the affected area.
If your child is born with Amniotic Band Syndrome and has foot deformities, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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