clinical features

Background

Definition

 

Congenital Talipes Equinovarus

 

Congenital abnormality of the foot characterised by 

- hindfoot equinus & varus 

- forefoot Adduction

- midfoot Supination

 

Latin: talus - ankle / pes - foot / equinus - horse like

 

Clinical

 

Foot

- pipe stem calf

- short wide foot

- small heel

- curved lateral border

Background

Definition

 

CP is a permanent disorder of movement and posture 

- non-progressive 

- brain injury before the age of two years

 

Strict definition excludes familial & progressive congenital problems & those acquired in childhood as a result of head injuries

 

Incidence

 

2-3 per 1000 live births

 

Higher in 

Transient Osteoporosis Hip

Definition

 

Self limiting syndrome of unknown aetiology

- hip pain associated with osteoporosis of proximal femur 

 

DDx

 

AVN

- AVN of the hip in pregnancy is rare but possible

- TOH tends to be diffuse on MRI, while AVN is localised

- extends to neck and metaphysis

- transient osteoporosis has normal bone scan

 

Incidence

 

Rare

- M: F 3:1

Osteoid Osteoma

Definition

 

Benign, bone-forming neoplasm

- characterized by a small nidus of neoplastic tissue

- surrounded by a wide zone of mature, reactive bone

 

Epidemiology

 

10% of benign bone tumours

Age 5-25

M:F 2:1

 

Aetiology

 

Unknown

- thought may be glomus tumour of bone

 

Pain secondary to prostaglandin production

 

Gas Gangrene

Definition

 

Clostridial Myonecrosis

- necrotizing, gas producing infection of skeletal muscle 2° Clostridia

- life threatening & rapidly progressive

 

Classification

 

There are 3 types of bacterial gas-forming infections

 

1. Classical clostridial gas gangrene

- rapid onset of sepsis / couple of days

- muscle nearly always involved

- critically ill immediately following an open injury 

Insertional Achilles Tendinopathy

Definition

 

Inflammation of achilles tendon; insertional or noninsertional

 

Spectrum

 

Tendonitis / Tendonosis / Rupture

 

Anatomy

 

Triceps surae

- medial and lateral gastrocnemius

- soleus

- surrounded by paratenon which allows gliding and supplies nutrition

 

Inserts middle 1/3 calcaneal tuberosity

- 2 x 2 cm area

- 90o rotation distally

 

Retrocalcaneal bursa (x2)

Plantar Warts

Pathology

 

Human papilloma virus

 

Occur in any part of sole

 

Clinical Features

 

Do not project above level of skin

- because of pressure of weight bearing

- seldom more than 1cm in diameter

- skin surrounding wart thickened and raised

- edge clearly demarcated from surrounding skin

 

Severe localised pain on walking

 

Local tenderness on pressure

 

Vertebral Osteomyelitis

Epidemiology

 

M:F =2:1

 

30-40 years

 

20% diabetic

 

50-80% identifiable source

 

Site

 

Lumbar (50%) > Thoracic > Cervical (<10%)

 

Pathogenesis

 

1.  Haematogenous

- arterial rather than venous

 

Risk factors

- UTI (40% of all cases)

- IVDU

- elderly

Epidural Abscess

Definition

 

Pus collection in the epidural space

 

Epidemiology

 

Usually haemotogenous seeding

 

Very rare

- 37 / 1 000 000 patients with LBP

- 1 /10 000 admissions

- most common in old men

 

Average age 68 years

 

3/4 males

 

Rare in paediatrics