Slide 039 — MT adductus and skew foot

Clean FRCS notes with inline figures

MT adductus and skew foot

•Skew foot = Heel in valgus but forefoot adducted

•Associated with “packaging”

•Torticollis

•DDH

•Knee dislocation

•CTEV (?)

•Clinical

•Intoeing

•Ddx: femoral anteversion, tibial intorsion

•must rule out DDH, blounts

Natural history by Ponseti – 88% spontaneous resolution

Classification

•Berg – include skew foot

•Simple MTA

•Complex MTA – MTA + midfoot lateral shift

•Simple Skew – MTA + hindfoot valgus

•Complex skew – simple skew + midfoot lateral shaft

•Bleck – MTA

•Heel bisector line

•2,3

•3

•3,4

•4,5

•Mx for MTA

•Mild – correct beyond 2nd web – observe

•Mod – correct to 2nd web – stretch

•Severe – correct not to 2nd web – casting

•Failed – OT at 4 yo, cuboid shortening + 1st MC lengthening

•Skew foot

•Deformity

•Hindfoot valgus

•Midfoot abduction (TNJ lateral subluxation)

•FF adduction

Causes:

•NM

•Arthrogryposis

•Iatrogenic - improper casting for MT adductus

Management

•Cast first

•Osteotomy (refractory)

•Calcaneus lateral opening wedge

•Medial cuneiform medial opening wedge

Direct Q&A

Q1 What diagnostic or radiographic findings support MT adductus and skew foot?

MT adductus and skew foot

•Skew foot = Heel in valgus but forefoot adducted

•Associated with “packaging”

•Torticollis

•DDH

•Knee dislocation

•CTEV (?)

•Clinical

•Intoeing

•Ddx: femoral anteversion, tibial intorsion

Q2 How is MT adductus and skew foot classified here?

•Berg – include skew foot

•Simple MTA

•Complex MTA – MTA + midfoot lateral shift

•Simple Skew – MTA + hindfoot valgus

•Complex skew – simple skew + midfoot lateral shaft

•Bleck – MTA

•Heel bisector line

•2,3

•3

•3,4

•4,5

•Mx for MTA

•Mild – correct beyond 2nd web – observe

•Mod – correct to 2nd web – stretch

•Severe – correct not to 2nd web – casting

•Failed – OT at 4 yo, cuboid shortening + 1st MC lengthening

•Skew foot

•Deformity

•Hindfoot valgus

•Midfoot abduction (TNJ lateral subluxation)

•FF adduction

Q3 How is MT adductus and skew foot managed?

Cast first

•Osteotomy (refractory)

•Calcaneus lateral opening wedge

•Medial cuneiform medial opening wedge

Raw speaker-note hierarchy audit

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	MT adductus and skew foot
2	0	None	None	0	Skew foot = Heel in valgus but forefoot adducted
3	0	None	None	0	Associated with “packaging”
4	0	171450	-171450	1	Torticollis
5	0	171450	-171450	1	DDH
6	0	171450	-171450	1	Knee dislocation
7	0	171450	-171450	1	CTEV (?)
8	0	0	0	0	Clinical
9	0	171450	-171450	1	Intoeing
10	1	628650	-171450	2	Ddx: femoral anteversion, tibial intorsion
11	1	628650	-171450	2	must rule out DDH, blounts
12	0	0	0	0	Natural history by Ponseti – 88% spontaneous resolution
13	0	0	0	0	Classification
14	0	0	0	0	Berg – include skew foot
15	1	685800	-228600	2	Simple MTA
16	1	685800	-228600	2	Complex MTA – MTA + midfoot lateral shift
17	1	685800	-228600	2	Simple Skew – MTA + hindfoot valgus
18	1	685800	-228600	2	Complex skew – simple skew + midfoot lateral shaft
19	0	0	0	0	Bleck – MTA
20	0	0	0	0	Heel bisector line
21	1	457200	0	1	2,3
22	1	457200	0	1	3
23	1	457200	0	1	3,4
24	1	457200	0	1	4,5
25	0	0	0	0	Mx for MTA
26	0	0	0	0	Mild – correct beyond 2nd web – observe
27	0	0	0	0	Mod – correct to 2nd web – stretch
28	0	0	0	0	Severe – correct not to 2nd web – casting
29	0	0	0	0	Failed – OT at 4 yo, cuboid shortening + 1st MC lengthening
30	0	0	0	0	Skew foot
31	0	0	0	0	Deformity
32	0	171450	-171450	1	Hindfoot valgus
33	0	171450	-171450	1	Midfoot abduction (TNJ lateral subluxation)
34	0	171450	-171450	1	FF adduction
35	0	0	0	0	Causes:
36	0	171450	-171450	1	NM
37	0	171450	-171450	1	Arthrogryposis
38	0	171450	-171450	1	Iatrogenic - improper casting for MT adductus
39	0	0	0	0	Mx:
40	0	171450	-171450	1	Cast first
41	0	171450	-171450	1	Osteotomy (refractory)
42	1	628650	-171450	2	Calcaneus lateral opening wedge
43	1	628650	-171450	2	Medial cuneiform medial opening wedge

lvl

marL

indent

logical

original note line

None

MT adductus and skew foot

None

Skew foot = Heel in valgus but forefoot adducted

None

Associated with “packaging”

171450

-171450

Torticollis

171450

-171450

DDH

171450

-171450

Knee dislocation

171450

-171450

CTEV (?)

Clinical

171450

-171450

Intoeing

628650

-171450

Ddx: femoral anteversion, tibial intorsion

628650

-171450

must rule out DDH, blounts

Natural history by Ponseti – 88% spontaneous resolution

Classification

Berg – include skew foot

685800

-228600

Simple MTA

685800

-228600

Complex MTA – MTA + midfoot lateral shift

685800

-228600

Simple Skew – MTA + hindfoot valgus

685800

-228600

Complex skew – simple skew + midfoot lateral shaft

Bleck – MTA

Heel bisector line

457200

2,3

457200

3,4

457200

4,5

Mx for MTA

Mild – correct beyond 2nd web – observe

Mod – correct to 2nd web – stretch

Severe – correct not to 2nd web – casting

Failed – OT at 4 yo, cuboid shortening + 1st MC lengthening

Skew foot

Deformity

171450

-171450

Hindfoot valgus

171450

-171450

Midfoot abduction (TNJ lateral subluxation)

171450

-171450

FF adduction

Causes:

171450

-171450

171450

-171450

Arthrogryposis

171450

-171450

Iatrogenic - improper casting for MT adductus

Mx:

171450

-171450

Cast first

171450

-171450

Osteotomy (refractory)

628650

-171450

Calcaneus lateral opening wedge

628650

-171450

Medial cuneiform medial opening wedge

Improved semantic hierarchy used for the study notes

#	semantic level	section?	rewritten line
1	0		MT adductus and skew foot
2	1		Skew foot = Heel in valgus but forefoot adducted
3	1		Associated with “packaging”
4	1		Torticollis
5	1		DDH
6	1		Knee dislocation
7	1		CTEV (?)
8	1		Clinical
9	1		Intoeing
10	2		Ddx: femoral anteversion, tibial intorsion
11	2		must rule out DDH, blounts
12	0	yes	Natural history by Ponseti – 88% spontaneous resolution
13	0	yes	Classification
14	1		Berg – include skew foot
15	2		Simple MTA
16	2		Complex MTA – MTA + midfoot lateral shift
17	2		Simple Skew – MTA + hindfoot valgus
18	2		Complex skew – simple skew + midfoot lateral shaft
19	1		Bleck – MTA
20	1		Heel bisector line
21	1		2,3
22	1		3
23	1		3,4
24	1		4,5
25	1		Mx for MTA
26	1		Mild – correct beyond 2nd web – observe
27	1		Mod – correct to 2nd web – stretch
28	1		Severe – correct not to 2nd web – casting
29	1		Failed – OT at 4 yo, cuboid shortening + 1st MC lengthening
30	1		Skew foot
31	1		Deformity
32	1		Hindfoot valgus
33	1		Midfoot abduction (TNJ lateral subluxation)
34	1		FF adduction
35	0	yes	Causes:
36	1		NM
37	1		Arthrogryposis
38	1		Iatrogenic - improper casting for MT adductus
39	0	yes	Management
40	1		Cast first
41	1		Osteotomy (refractory)
42	2		Calcaneus lateral opening wedge
43	2		Medial cuneiform medial opening wedge

semantic level

section?

rewritten line

MT adductus and skew foot

Skew foot = Heel in valgus but forefoot adducted

Associated with “packaging”

Torticollis

DDH

Knee dislocation

CTEV (?)

Clinical

Intoeing

Ddx: femoral anteversion, tibial intorsion

must rule out DDH, blounts

yes

Natural history by Ponseti – 88% spontaneous resolution

yes

Classification

Berg – include skew foot

Simple MTA

Complex MTA – MTA + midfoot lateral shift

Simple Skew – MTA + hindfoot valgus

Complex skew – simple skew + midfoot lateral shaft

Bleck – MTA

Heel bisector line

2,3

3,4

4,5

Mx for MTA

Mild – correct beyond 2nd web – observe

Mod – correct to 2nd web – stretch

Severe – correct not to 2nd web – casting

Failed – OT at 4 yo, cuboid shortening + 1st MC lengthening

Skew foot

Deformity

Hindfoot valgus

Midfoot abduction (TNJ lateral subluxation)

FF adduction

yes

Causes:

Arthrogryposis

Iatrogenic - improper casting for MT adductus

yes

Management

Cast first

Osteotomy (refractory)

Calcaneus lateral opening wedge

Medial cuneiform medial opening wedge

039. MT adductus and skew foot

Clean FRCS notes with inline figures

MT adductus and skew foot

Natural history by Ponseti – 88% spontaneous resolution

Classification

Causes:

Management

Direct Q&A

MT adductus and skew foot

Cast first

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes