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Forefoot and midfoot pain in the active child or skeletally immature adolescent: Overview of causes

INTRODUCTION

An overview of the causes of forefoot and midfoot pain in active children and skeletally immature adolescents will be reviewed here.

An overview of causes of heel and ankle pain and evaluation of foot pain and injury in children are discussed separately. (See "Heel pain in the active child or skeletally immature adolescent: Overview of causes" and "Ankle pain in the active child or skeletally immature adolescent: Overview of causes" and "Foot and ankle pain in the active child or skeletally immature adolescent: Evaluation".)

The foot can be divided into three functional parts: the hindfoot, midfoot, and forefoot as follows ( figure 1) [ 1]:

● Hindfoot - The hindfoot, which consists of the talus and the calcaneus, connects to the midfoot at the midtarsal (Chopart) joint.

● Midfoot - The midfoot contains the navicular, the cuboid, and the three cuneiform bones; it connects to the forefoot at the Lisfranc joint.

Literature review current through: Jun 2022. | This topic last updated: Feb 25, 2022.

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2022 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

REFERENCES

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2. Lipman GS, Krabak BJ. Foot problems and care. In: Wilderness Medicine, 6th edition, Auerbach PS (Ed), Elsevier Mosby, Philadelphia 2012. p.580.

3. Waldrop NE 3rd, Zirker CA, Wijdicks CA, et al. Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot Ankle Int 2013; 34:403.

4. Yagerman SE, Cross MB, Positano R, Doyle SM. Evaluation and treatment of symptomatic pes planus. Curr Opin Pediatr 2011; 23:60.

5. Winfeld MJ, Winfeld BE. Management of pediatric foot deformities: an imaging review. Pediatr Radiol 2019; 49:1678.

6. Bouchard M, Mosca VS. Flatfoot deformity in children and adolescents: surgical indications and management. J Am Acad Orthop Surg 2014; 22:623.

7. Carr JB 2nd, Yang S, Lather LA. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics 2016; 137:e20151230.

8. Jane MacKenzie A, Rome K, Evans AM. The efficacy of nonsurgical interventions for pediatric flexible flat foot: a critical review. J Pediatr Orthop 2012; 32:830.

9. Techdijan MO. Clinical Pediatric Orthopedics: The Art of Diagnosis and the Principles of Management, Appleton and Lange, Philadelphia 1997.

10. Kasser JR. The foot. In: Lovell and Winter's Pediatric Orthopaedics, 6th ed, Morrissey RT, Weinstein SL (Eds), Lippincott, Williams & Wilkins, Philadelphia 2001. p.1257.

11. Dare DM, Dodwell ER. Pediatric flatfoot: cause, epidemiology, assessment, and treatment. Curr Opin Pediatr 2014; 26:93.

12. Frances JM, Feldman DS. Management of idiopathic and nonidiopathic flatfoot. Instr Course Lect 2015; 64:429.

13. Wicart P. Cavus foot, from neonates to adolescents. Orthop Traumatol Surg Res 2012; 98:813.

14. Schwend RM, Drennan JC. Cavus foot deformity in children. J Am Acad Orthop Surg 2003; 11:201.

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18. Sanal HT, Chen L. Lateral foot pain : Diagnosis : Iselin's disease. Skeletal Radiol 2015; 44:1705.

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20. Zaw H, Calder JD. Tarsal coalitions. Foot Ankle Clin 2010; 15:349.

21. Stormont DM, Peterson HA. The relative incidence of tarsal coalition. Clin Orthop Relat Res 1983; :28.

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Forefoot and midfoot pain in the active child or skeletally immature adolescent: Overview of causes - UpToDate

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An overview of the causes of forefoot and midfoot pain in active children and skeletally immature adolescents will be reviewed here.An overview of causes of hee

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Pie equino varo
1 por cada mil niños, el 50% de los casos bilateral y es el doble más frecuente en niños que en niñas.
Caminarán sobre el borde lateral o las puntas de los pies.
Formación de callosidades, con potencial infección de la piel y del hueso e imposibilidad de llevar calzado normal.

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pie con aplanamiento de la bóveda plantar (o disminución del arco longitudinal plantar) + valgo del talón (calcáneo desviado hacia afuera). Frecuentemente es BILATERAL

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pie en equino (flexión plantar, como si nos pusiésemos de puntillas) + varo (desviación del talón hacia interno) + addución (El antepié se desvía hacia dentro) + supinación (la planta del pie mira hacia dentro).

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Dolor, deformidad y/o alteración de la marcha
Es el más frecuente, se da en niños de 3-10 años

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Se caracteriza por la desviación lateral del talón que mira hacia fuera y puede estar asociada al pie plano. El arco plantar disminuye y la carga se desplaza hacia la zona media del pie.

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Integrantes
Andrea Alexander
Steven Alarcon
Gabriela Rengifo

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Considerando la edad de la paciente y la persistencia de las deformidades descritas en ambos pies ¿Cuáles serían sus posibles diagnósticos ?

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- Marcha Dolorosa y claudicante con deformidad de ambos pies en pronación y valgo en el retropié
- Articulación subastragalina rígida
- Disminución de los movimientos de inversión y eversión

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Alejandra de 6 años de edad, nacida y residente en Sageon Cantón Biblián, acude a consulta por presentar dolor de pies. La madre refiere alteración en la marcha, acompañada de dolor de pies, específicamente en el mediopié, asi como deformidad en el calzado, el cual tiene que cambiar cada dos meses. El padre lleva estudios de imagen previamente solicitados por un facultativo previo. Por recomendación médica usa platillas, pero el cuadro no mejora.