Russell, Kevin et al.

Thanks very much for the opinion - it’s much appreciated. Somehow I knew I
was going to have to dust off the old textbooks for this one. A couple of
additional points if I may.

With regard to the position of the foot. It is neither plantar grade or
dorsiflexed – it is what I would term as a neutral mid-stance position i.e.
at right angles with the lower leg. Passive movement allows slightly
greater dorsiflexion than plantarflexion – but only slightly. There is
severe resistance after the few degrees of movement is reached. In essence
the ankle joint feels ‘locked’. If it is soft tissue contracture then it is
not demonstrating a great deal of elasticity.

I think I’ll have a look at the radiograph plates – I have only been given
the report so far – and look again at the T-N relationship before I proceed
further. I have to say I can see no rearfoot abnormality to the extent of a
severe calcaneovalgus but my experience with this age of infant is fairly
limited.

One last point. The mother made remark that it took some time for the ‘leg
to come down’ and I thought initially there may have been some restriction
at the hip joint. But what if there was some pathology at the knee- such as
subluxed superior tib-fib joint? Is there not a relationship between this
and calcaneovalgus in adults? If there was discomfort here the natural
position would be to flex the knee and keep the leg raised. Shoot me down
if I’m wide of the mark.

Many thanks again.

Mark Russell

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