Case of the week: 8-9-2006


 

Joint laxity with valgus feet and intoeing

Age: 4y 9mo

History

        surviving twin (the other miscarried at approx. 10 weeks)

        birth weight 8lb 14 oz: normal delivery, initially a little cold

        didn't respond to sound though hearing tests under GA showed normal hearing

        very quiet/placid baby

        floppy tone

Development

        favoured left hand by 6 mo.

        would not weight-bear at all until 12 mo...legs just hung "frog like" when held up

        crawled commando-style, pulling himself along on left forearm

        walked at 17 mo. following physiotherapy

        low tone in trunk and all 4 limbs (tone not altered by effort)

        inability to lift head clear of the floor when supine

Physical exam

        significantly increased range of movement in all joints

        leg lengths equal

        valgus feet - left more than right, stands with weight along medial edge of both feet

        bilateral intoeing

        inadequate foot clearance

        becomes fatigued very easily

Gait

        currently wears a static AFO on his right on weekdays with a heel cup on weekends

        has a heel cup for the left every day and wears piedro boots.

        has tried heel cups in normal shoes but left shoe especially became slightly misshapen within 2 hr. and totally within 2 days

        on the waiting list (approx 6-9 months) for 3D gait analysis

Movies
 

With AFOs and heel cup 1

MPG format

With AFOs and heel cup 2

MPG format

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