1. Lower limb deformities
MUDr. Zdeněk Matějovský, CSc.
Ortopedická klinika 1. LF UK FN Bulovka Praha

2. Definition
Deformity is mutilation caused by: congenital / developmental aberration -as result of accident or disorder
any deviation of normal proportions
In strict sense any deviation of axis

3. Sorting according to origin
Congenital
Transversal (whole cross-section) 1/3
Longitudinal (in sagital plaine) distal to elbow/knee
Acquired
disorder (rachitis, arthtrosis)
after injury

4. Sorting according to plane of deformity
1/ Sagital plane: bone - antecurvation, retrocurvation joint - flexion, extension
2/ Frontal plane: varous, valgous joint– adduction, abduction
3/ Rotation anteversion, retroversion
4/ Combined: equinovarus

5. Congenital deformities of lower limb
Endogenic factors - genetic f.
Exogenic factors - teratogenic f., uterus abnormality, machanical force, ionisation, drugs

6. Congenital deformities of lower limb
Amnial bands syndrom (Thalidomid)
Femur-fibula-(ulna) syndrom (FFU)
Congenital pseudoarthrosis of shin – distal tibia. Boyd (antecurvation/thickness/cyst/ stress fracture). Therapy allograft from mother, resection, compression and distraction on external fixateur, amputation
Congenital pseudoarthrosis of femur (PFFD) – proximal femur. Pappas I.-IX. Treatment: reposition, retention, PF distraction, renewal, plastic surgery
DCC, PEC

7. Acquired deformities of lower limb
Result of injury Epiphyseal fractures – SH III, IV, SH V, med. tibia, distal femur Adult fractures – losing, comminutive fractures
Disorders: Bones - M. Blount, Rachitis Joints - osteoartrosis, RA, inflamations
Acquired deformities of foot and digits

8. Hip joint Coxa valga subluxans
Part of DCC, rotational and valgus component
treatment: DVO, eventual pelvic osteotomy
Coxa vara congenita
Acquired deformity with capital slide (slipped femoral capital epiphysis)
Treatment: intertrochanteric or cervical OT

9. Knee joint Genu varum After inflammation, Blount disease, rachitis.
Therapy:
High tibial OT Epiphyseodesis, epiphyseal distraction, extension by external fixateur
Genu valgum
After inflammation, rachitis, chondrodystrophy.
Therapy
supracondylic femoral OT, epifyzeodesis, epifyzeodistraction, prolongation.

10. Knee joint Genu recurvatum Rachitis, result of injury
Therapy: symptomatic, wedged OT, correction with external fixateur
Genu flextum
degenerative arthrosis, rheumatic arthritis, haemophilia
total knee arthroplasty, redress

11. Foot deformities
Congenital structural (non-reducible) positional (reducible)
Acquired static(due to overloading) secondary (after injuries/disorders)

12. Foot deformities Pes equinus Pes excavatus
Pes planovalgus (valgus foot)
Pes transversoplanus (flatfoot)

13. Static deformities of forefoot
Hallux valgus
Hallux varus
Hallux rigidus
Digitus malleus (Drumstick finger) DIP
Digitus hamatus (Hammer finger) PIP