Cause: Idiopathic avascular necrosis (AVN) of the navicular bone.
Development: Navicular is the last bone to ossify in the foot.
Symptoms: Pain, limping, weight-bearing on the lateral border of the foot.
Natural History: Navicular reconstitutes naturally within 18 months; symptoms improve before that.
Treatment: Short period of restricted weight-bearing with a plaster cast.
Curly Toes
Cause: Contracture of the flexor digitorum longus (FDL) or flexor digitorum brevis (FDB), usually affecting the lateral three toes.
Treatment: Tenotomy of FDL around age 3 if symptomatic.
Polydactyly
Description: Presence of extra toes, commonly on the lateral (post-axial) side.
Family History: Often positive.
Associated Conditions: Linked with congenital hallux varus.
Treatment: Typically, the most lateral toe is removed, considering both bony and soft tissue components. Optimal age for surgery is around 9-12 months.
Congenital Hallux Varus
Associated Conditions: Linked with polydactyly.
Anatomy: Short, thick first metatarsal (MT); adductor hallucis longus is the deforming muscle.
Treatment: Rarely requires surgery; if indicated, involves release of adductor hallucis longus and possibly osteotomy.
Overlapping Toe
Description: Usually affects the 5th toe overlapping the 4th toe.
Symptoms: May cause issues with footwear.
Treatment Options:
Stretching (often successful).
Syndactylization of the 5th and 4th toes.
Tenotomy.
Accessory Navicular
Prevalence: Present in about 12% of the population.
Symptoms: Often asymptomatic but associated with flatfoot.
Natural History: Tends to fuse with growth.
Treatment: If symptomatic, excision is effective, usually confirmed with a diagnostic injection first.
Habitual Toe Walking
Cause: Often due to tight Achilles tendon.
Natural History: Usually resolves spontaneously.
Treatment: May require serial casting or Achilles lengthening if persistent.
Ball and Socket Ankle
Description: A compensatory mechanism to increase ankle movement, often associated with other rigidity issues.
Associations:
Tarsal coalition (50% of cases).
Absence of lateral rays (50%).
Etiology: Generally congenital, sometimes part of conditions like fibula hemimelia.
Juvenile Bunions
Gender Prevalence: Girls > Boys.
Management: Avoid surgery where possible to prevent recurrence due to growth; accommodative shoe wear is recommended.
Surgical Consideration: Ensure the first ray is not hypermobile if surgery is considered.
Iselin’s Disease
Description: Traction apophysitis of the 5th metatarsal (MT) base.
Management: Non-operative treatment.
Sever’s Disease
Description: Traction apophysitis of the calcaneal apophysis.
Age Range: Typically affects children aged 7-15 years.