|Reviewed by Starship Orthopaedic Service|
|Abnormalities of Hands, Feet and Digits||Arthrogryposes||Developmental Dysplasia of the Hips|
There is a Paediatric Orthopaedic Team at Starship Hospital. Referral to an Orthopaedic Surgeon should not be carried out before a baby has been seen by a Consultant Paediatrician.
They will either visit National Women's Hospital within the first week to 10 days of life, or request that the infant be given an appointment to their weekly outpatient clinic at Starship Children's Hospital.
Talipes equinovarus referrals should be sent to the Paediatric Orthopaedic Department at Starship Hospital as soon as possible.
It is not uncommon for babies to have flexible calcaneo-valgus feet, where the foot is apposed to the dorsum of the tibia. These feet usually respond to gentle passive stretching into plantar flexion by the parents at each nappy change. The baby should be referred to the orthopaedic department but we will usually not see the baby until the age of 3-4 months with an X-ray of the hips (as these foot positional problems can be associated with hip dysplasia). Apart from the hips, other things to check when there is a calcaneo-valgus foot deformity is the length of the leg below the knee and the presence of the fibula (by palpation) – if the fibula is missing at the ankle, then this is a fibular hemimelia, not a calcaneo valgus foot.
Feet with a rocker bottom, rigid deformity that is not flexible may represent a vertical talus which is a fixed dislocation of the talonavicular joint. These feet may need to be x-rayed and it is recommended that specialist Orthopaedic Radiology be performed at Starship Hospital. This would normally be arranged after consultation with the Orthopaedic Surgeon. Treatment is often initially with casting at an early age and then surgery later if this is not successful. Note that children with vertical talus often have other congenital deformities or associated syndromes, so vertical talus without other associated conditions is very rare.
Hand referrals can be seen by the Paediatric Orthopaedic Registrar for the Bidwell/Beagley team if acute review is needed. Otherwise, appropriate inpatient or outpatient consultation with Dr Bidwell (Orthopaedic Hand Surgery) and Mr Beagley (Plastic Hand Surgery) can be arranged. This includes neonatal brachial plexus palsies, duplicate digits, syndactyly and other conditions such as arthrogryposis. For these conditions, there is generally no immediate surgical treatment, so the first appointment is to assess the problem and discuss the timing of any necessary intervention.
NB: If a neonatal compartment syndrome is suspected, this is an emergency and the on call Paediatric Orthopaedic Registrar should be contacted immediately.
This is a complex group of disorders which may result from intrauterine compression or underlying neuromuscular disorder. This should be considered when making assessment and referral, particularly where neurological problems are suspected.