In those less than eight years old with simple in-toeing and minor symptoms, no specific treatment is needed. Metatarsus Adductus Nonoperative management: Non operative treatment of metatarsus adductus is dictated by the flexibility of the forefoot. If the child can actively correct the forefoot to midline no treatment is indicated. If the adduction cannot be corrected actively but is flexible in passive correction by an examiner, at-home stretching that mimics this maneuver can be performed by parents. In the case of a rigid deformity serial casting can straighten the foot. Surgical Management: Most cases of metatarsus adductus that does not resolve is asymptomatic in adulthood and does not require surgery. Occasionally, persistent rigid metatarsus adductus can produce difficulty and significant pain associated with inability to find accommodating footwear. Surgical options include tasometatarsal capsulotomy with tendontransfers or tarsal osteotomies. Due to the high failure rate of capsulotomy and tendon transfer it is generally avoided. Osteotomy (cutting of bone) and realignment of the medial cuneiform, cuboid, or second through fourth metatarsal the safer and most effective surgery in patients over the age of 3 years old with residual rigid metatarsus adductus. Internal Tibial Torsion Nonoperative management: There are no bracing, casting, or orthotic techniques that have been shown to impact resolution of tibial torsion. This rotational limb variant does not increase risk for functional disability or higher rates of arthritis if unresolved. Management involves parental education and observational visits to monitor for failure to resolve. Surgical management: Indications for surgical correction are a thigh foot angle greater tan 15 degrees in a child greater than 8 years of age that is experiencing functional limitations because of their condition. Surgical correction is achieved most commonly through a tibial derotational osteotomy. This procedure involves the cutting (osteotomy) and straightening (derotation) of the tibia, followed by internal fixation to allow the bone to heal in place. Femoral Anteversion Nonoperative management: Nonoperative treatment includes observation and parental education. Treatment modalities such as bracing, physical therapy, and sitting restrictions have not demonstrated any significant impact on the natural history of femoral anteversion. Surgical management: Operative treatment is reserved for children suffering significant functional or cosmetic difficulties due to residual femoral anteversion greater than 50 degrees or internal hip rotation greater than 80 degrees after age 8. Surgical correction is achieved though a femoral derotation osteotomy. This procedure involves the cutting (osteotomy) and straightening (derotation) of the femur, followed by internal fixation and to allow the bone to heal in place.
Pigeon toe
Clubfoot
Trigger finger
Pincer nail
Jersey finger
Trench foot
Hammer toe
Jammed finger