Posted by: Indonesian Children | August 15, 2009

The Newborn Foot : Examination Techniques

An examination of the feet is an essential component of an evaluation of a newborn. A thorough examination can be performed quickly. Despite its small size, the newborn foot is a complex structure. Most deformities can be diagnosed easily with physical examination alone, using few diagnostic studies. A thorough examination includes assessment of vascular, dermatologic, and neurologic status of the lower extremities, and observation, palpation, and evaluation of joint range of motion in both feet. Common newborn foot abnormalities include metatarsus adductus, clubfoot deformity, calcaneovalgus (flexible flatfoot), congenital vertical talus (rigid flatfoot), and multiple digital deformities–polydactyly, syndactyly, overlapping toes, and amniotic bands. Most treatments include conservative measures, such as observation, stretching, and splinting, which can be performed easily in the family medicine setting. Cases that require surgical correction should be referred to a subspecialist with expertise in correcting lower extremity deformities in children. When surgery is indicated, procedures generally are postponed for six to nine months so that the child will better tolerate anesthesia. (Am Fam Physician 2004;69:865-72. Copyright© 2004 American Academy of Family Physicians.)  {short description of image}  
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The examination of the feet is an essential component of a comprehensive evaluation of a newborn. With proper skills, this examination, which often is reassuring to new parents, can be performed quickly, yet thoroughly. Early detection of foot problems in infants allows timely corrective treatment, if required.

Examination Techniques

Despite its small size, the newborn foot is complex, consisting of 26 to 28 bones. The foot can be divided into three anatomic regions (Figure 1): the hindfoot or rearfoot (talus and calcaneus); the midfoot (navicular bone, cuboid bone, and three cuneiform bones); and the forefoot (metatarsals and phalanges). Differences between a newborn foot and an adult foot are summarized in Table 1.

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TABLE 1
Differences Between the Newborn and Adult Foot

Feature


Newborn


Adult


Arch Flatter, less defined Usually well defined, except in pes planus
Typical joint range of motion Greater range of motion Lesser range of motion
End point of range of motion Soft, subtle, difficult to appreciate Firm, well defined
Amount of subcutaneous fat tissue Greater Lesser
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Simultaneous observation of both feet can reveal many deformities. The skin should be examined for unusual creases or folds that can be formed by various foot deviations. Certain areas of the skin might be abnormally taut, indicating extra tension on the skin, while the skin on the opposite side of the foot might reveal loose, excessive skinfolds.

During the next part of the examination, various foot and ankle joints are moved through their respective ranges of motion. The joints should be assessed for flexibility or rigidity, unusual positions, lack of motion, and asymmetry.

Finally, the vascular examination consists of assessment of capillary refill and skin color, because pulses are difficult to palpate. Fortunately, the majority of newborns exhibit excellent lower extremity vascular supply, unless it is compromised by an extrinsic factor, such as an intrauterine amniotic band.

illustration
FIGURE 1. Bone structure and divisions of the adult foot.

Reference :

  1. Hoffinger SA. Evaluation and management of pediatric foot deformities. Pediatr Clin North Am 1996;43:1091-111.
  2. Hoffinger SA. Evaluation and management of pediatric foot deformities. Pediatr Clin North Am 1996;43:1091-111.
  3. Mankin KP, Zimbler S. Gait and leg alignment: what’s normal and what’s not. Contemp Pediatr 1997;14:41-70.
  4. Connors JF, Wernick E, Lowy LJ, Falcone J, Volpe RG. Guidelines for evaluation and management of five common podopediatric conditions. J Am Podiatr Med Assoc 1998;88:206-22.
  5. Churgay CA. Diagnosis and treatment of pediatric foot deformities. Am Fam Physician 1993;47:883-9.

 

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email : judarwanto@gmail.com,

 

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