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