REVIEWS   

Chirurgia Del Piede 2006 December;30(3):137-46

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

The modern approach to children’s foot problems

Pisani G.

Centro di Chirurgia del Piede Casa di Cura “Fornaca di Sessant”, Torino

It is difficult to decide to what extent an approach to children’s foot problems can be defined as modern because even though the evolution of shared knowledge is considered, it is not possible to separate this from the physician’s personal experience that has very often arisen from his own roots and is in contrast at times with otherwise known exceptions. It must be remembered that a child’s foot is not the foot of an adult in miniature. The development course of this foot must be clarified up to its parametrisation at values proper to the adult, bearing in mind its evolutive insertion in the context of the lower extremity as regards torsional and rotator moments and axial structure. As regards the important evolutive moments, the asynchronous evolution of the ankle bone and heel from embryo to adult; in addition, the evolution of heel, ankle and plantar flexor apparatus on the way to verticalisation of the rear of the foot. Given the concepts of torsion and rotation, it is necessary in pathological situations to evaluate segmentary torsions (femur, tibia, talar neck) in the global context of the lower extremity and in relation to the angle of functional declination of the ankle bone. And it is also necessary to correctly interpret rotatory misalignment (patellar strabism for example) which on many occasions is reflected in foot dysmorphisms (cavo-valgus foot).