The Cavovarus Foot in Hereditary Motor and Sensory Neuropathies

Are you sure that ankle is just sprained? A review of common ankle conditions, diagnoses and treatment

PURPOSE OF REVIEW

Acute ankle sprains frequently occur in active children and adolescents but may be the initial clinical presentation of other less common disorders affecting the lower extremities. There are many conditions that may cause one or multiple episodes of ankle injury that are misdiagnosed as an acute ankle sprain. This manuscript highlights diagnoses that should be considered when evaluating and managing a child or adolescent who presents initially and/or repeatedly with an acute ankle sprain.

RECENT FINDINGS

In recent years, various studies have continued to note the prevalence of misdiagnosed ankle sprains, especially amongst the paediatric population. If ankle radiographs demonstrate no abnormalities during an initial clinical examination, often the patient is diagnosed with an acute ankle sprain. However, this can be a misdiagnosis, especially when the patient has had recurrent episodes of ankle injury and ancillary studies are not performed.

SUMMARY

There are many diagnoses that can go unnoticed in the initial evaluation of a paediatric or adolescent ankle sprain. It is important for physicians to be aware of these other conditions to ensure proper treatment plans. This manuscript will analyse five conditions that may be misdiagnosed as an ankle sprain, including juvenile idiopathic arthritis, osteochondritis dissecans of the talus, hereditary sensory motor neuropathy (Charcot-Marie Tooth disease), tarsal coalition and transitional ankle fractures.

Understanding Radiographic Measurements Used in Foot and Ankle Surgery

Given the high volume of patient visits for foot and ankle complaints, developing a systematic approach to evaluation of foot and ankle pathology is important for orthopaedic providers. A thorough evaluation of weight-bearing radiographs is essential to differentiate acute and chronic injury from normal findings to dictate treatment. Radiographic changes and varying degrees of deformity can influence surgical considerations. The purpose of this article was to review and define radiographic measurements relevant to surgical decision making for common foot and ankle pathologies and treatment.

Neurologic Disorders and Cavovarus Deformity

A cavovarus deformity results from muscle imbalances in the foot. There are several etiologies of a cavovarus foot including congenital, neurologic, post-traumatic, and idiopathic. Charcot-Marie-Tooth disease is a common genetic cause of cavovarus foot. History, physical examination, and imaging help determine appropriate treatment. The deformity can be flexible or rigid and can present in children or adults, thus treatment should be individualized to the patient. Non-operative management includes shoe wear modification, physical therapy, and bracing. Operative management consists of soft tissue releases, tendon transfers, osteotomies, arthrodesis, and repair/reconstruction of lateral ankle ligaments and peroneal tendons.