Chapter 8 Clinical Connections

Genu valgum

A deformity in which the knees are abnormally close together and the space between the ankles in increased do a lateral angulation of the tibia in relation to the femur. Also called knock-knee.

Genu varum

A deformity in which the knees are abnormally separated and there is a medial angulation of the tibia in relation to the femur and the lower limbs are bowed laterally. Also called bowleg.

Clubfoot or Talipes Equinovarus

An inherited deformity in which the foot is twisted inferiorly and medially, and the angle of the arch is increased; occurs in 1 of every 1000 births. Treatment consists of manipulating the arch to a normal curvature by casts or adhesive tape, usually soon after birth. Corrective shoes or surgery may also be required.

Hallux valgus

Angulation of the great toe away from the midline of the body, typically caused by wearing tightly fitted shoes. When the great toe angles toward the next toe, there is a bony protrusion at the base of the great toe. Also called a bunion.

Bone Grafting

Generally consists of taking a piece of bone, along with its periosteum and nutrient artery, from one part of the body to replace missing bone in another part of the body. The transplanted bone restores the blood supply to the transplanted site, and healing occurs as in a fracture. The fibula is a common source of bone for grafting because even after a peice of the fibula has been removed, walking, running and jumping can be normal. Recall that the tibia is the weight bearing bone of the leg.

Clawfoot

Is a condition in which the medial longitudinal arch is abnormally elevated. It is often caused by muscle deformities, such as may occur in diabetics whose neurological lesions lead to atrophy of muscles of the foot.

Boxer's Fracture

Is a fracture of the fifth metacarpal, usually near the head of the bone. It frequently occurs ar a person punches another person or object, such as a wall. It is characterized by pain, swelling, and tenderness. There may also be a bump on the side of the hand. Treatment is either by casting or surgery, and fracture usually heals in about 6 weeks.

Hip Fracture

Most commonly applies to a break in the bones associated with the hip joint - the headm neck, trochanteric regions of the femur, or the bones that form the acetabulum. In the U.S., 300,000 to 500,000 people sustain hip fractures each year. The incidence of hip fractures is increasing, due in part to longer life spans. Decreases in bone mass due to osteoperosis, along with an increased tendency to fall, predispose elderly people to hip fractures.

Fractures of the Metatarsals

Occur when a heavy object falls on the foot or when a heavy object rolls over the foot. Such fractures are also common among dancers, especially in ballet dancers. If a ballet dancer is on the tip of her toes and looses her balance, the full body weight is placed on the metatarsals, causing one or more of them to fracture.

Hip Fractures

Often requires surgical treatment, the goal of which is to repair and stabilize the fracture, increase mobility, and decrease pain. Sometimes the repair is accomplished by using surgical pins, screws, nails, and plates to secure the head to the femur. In severe hip fractures, the femoral head or the acetabulum of the hip bone may be replaced by prostheses (artificial devices). The procedure of replacing either the femoral head of the acetabulum is hemiarthroplasty. Replacement of both the femoral head and acetabulum is total arthroplasty. The acetabular prosthesis is made of plastic, and the femoral prosthesis is made of metal; both are designed to withstand a high degree of stress. The protheses are attached to healthy portions of bone with acrylic cemenet and screws.

Patellofemoral stress syndrome

Runner's Knee, is one of the most common problems runners experience. During normal flexion and extension of the knee, the patella tracks (glides) superiorly and inferiorly in the groove between the femoral condyles. Normal tracking does not occur; instead the patella tracks laterally as well as superiorly and inferiorly, and the increased pressure on the joint causes aching or tenerness around or under the patella. The pain typically occurs after a person has been sitting for a while, especially after exercise. It is worsened by squatting or walking down stairs. One cause is constantly walking, running, or jogging on the same side of the road. Other predisposing factors include running on hills, running long distances, and anatomical deformity called genu valgum, or knock-knee.

Fractured Clavicle

The clavicle transmits force from the upper limb to the trunk. If the force transmitted to the clavicle is excessive, as when you fall on your outstretched arm, a fractured clavicle may result. May also result from a blow to the superior part of the anterior thorax. The clavicle is one of the most frequently broken bones of the body. Because the junction of the two curves of the clavicle is its weakest point, the clavicular midregion is the most frequent fracture site. Even in the absence of fr, compression of the clavicle as a result of automobile accidents involving the use of shoulder harness seatbelts often causes damage to the brachial plexus (the network of nerves that enter the upper limb), which lies between the clavicle and the second rib. A fractured clavicle is usually treated with a figure-of-8 sling to keep the arm from moving outward.

Pelvimetry

The measurement of the size of the inlet and outlet of the birth canal, which may be done by ultrasonography or physical examination. Measurement of the pelvic cavity in pregnant females is important because the fetus must pass through the narrower opening ohe pelvis at birth. A cesarean section is usually planned if it is determined that the pelvic cavity is too small to permit passage of the baby.

Flatfoot

When the ligaments and tendons weakened, the height of the medial longitudinal arch may decrease or "fall". The causes of which include excessive weight, postural abnormalities, weakened supporting tissues, and genetic predisposition. Fallen arches may lead to inflammation of the fascia of the sole (plantar faciitis), Achilles tendinitis, shin splints, stress fractures, bunionsm and calluses. A custom-designed arch support often is perscribed to treat flatfoot.