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Orthopaedic Anomaly Screening Program
SAC : Screening for Anomalies in Children
Essential for Common and Challenging Orthopaedic problems.
Presenting complaints, etiology and genetics enquiry should be obtained
Step-by-Step orderly clinical examination of the part and the child.
Sympathy, Kindness, Patience and Concern are key elements. Also considered are the wants and needs of the child and his parents.
a. Inspection (in stance and posture) and gait. Alignment, length & torsion.
b. Palpation i. Assessment of Deformities esp. Length discrepancy
ii. Range of Motion of joints ROM
iii. Testing of Muscle Power & Strength
iv. Neurological status examination
These are necessary to make a definitive diagnosis but a reasonable assessment could be done with clinical examination and ultrasound evaluation, though radiography takes the assessment to a higher level.
a. Radiography controlled views and with low dose radiation
b. Ultrasound examination
c. CT Low Dose rarely required
d. MRI with sedation control.
Laboratory Tests (Bone Profile)
CBC with ESR
Serum Alkaline Phosphatase
New Born Evaluation
3rd month screening
6th month screening
1 year screening
Foot and Ankle
Half length of foot Full length of foot Skeletal Maturity
Girls 1 year 12 years 12 years
Boys 1.5 years 16 years 14 years
Postural and Congenital Deformities of Foot and Ankle
Postural deformities of the new born are Metatarsus Primus Varus, Metatarsus Adductus, Postural Clubfoot, Pes Equinus & Valgus, Calcaneovalgus. Examine the whole body for other possible posture deformities.
Congenital deformities that cause Intoeing (Toeing-in) are Congenital Hallux Varus, Congenital Metatarsus Varus, Congenital talipesequinovarus CTEV, Ankle Varus due to short tibia.
Outoeing(Toeing-out) could be due to Calcaneovalgus, Pes Valgus-postural, Congenital Vertical Talus,
Footprint test, Plumbline Test, Toe-raising Test, Standing Radiography,
Congenital tarsal coalition is seen on plain radiography.
It is a manifestation of neuromuscular affection with dynamic imbalance of muscles of the foot or the body.
Congenital Vertical Talus
This uncommon birth deformity is rigid and often missed until later in infancy or still when the child begins to stand and walk. The foot is flat and has a an odd shape. The toes out and shoe doesn’t fit in well.
Orthopedic Surgeon could reassure for most of the deformities, complete and serial reviews are desirable.