The so-called sickle foot or pes adductus is found primarily in infants. This foot malposition usually resolves itself or can be corrected therapeutically.
What is a sickle foot?
Also known as pes adductus, sickle foot is a foot deformity that is considered to be the most common foot deformity among infants. For aids definitions, please visit definitionexplorer.com.
A sickle foot shows up when the forefoot of an affected person has an inward rotation. This inner bulge usually affects both the metatarsus and the toes. Depending on the cause of a sickle foot, the big toe can also deviate inwards. This is known as hallux varus. The heel position is often not affected with a sickle foot.
In many cases, sickle foot affects both feet. As a rule, a sickle foot is accompanied neither by pain nor by restrictions in the mobility of the affected person. Foot position is generally more common in boys than girls.
The cause of a sickle foot is initially in an increasingly active musculature of the so-called big toe adductor (a muscle that is responsible, among other things, for the application of the big toe to the foot) or the shinbone muscle.
A sickle foot can be congenital or acquired (developed after birth). Acquired sickle foot occurs more frequently and is usually less pronounced than congenital sickle foot. Acquired sickle foot often hides the fact that an affected infant is often in a prone position, which means that the toes often rest on the surface.
A congenital sickle foot can finally be hereditary or acquired. Sickle foot is hereditary when both parents of an affected infant have corresponding hereditary characteristics. An acquired, congenital sickle foot is probably often due to the relative narrowness of the uterus.
Symptoms, Ailments & Signs
A sickle foot can normally be recognized from the outside. The malformation manifests itself in the fact that the toes and metatarsus are turned inwards and the toes are partially or completely shifted inwards. The heel is typically bent inward or directed forward. The deformations normally have no influence on the mobility of the affected foot.
Pain is also rare and only occurs as a result of any misalignments. The congenital form also shows an inward gait. The sickle foot can occur on one or both sides. It usually occurs on both sides, although the severity of the symptoms can vary between the feet.
A congenital sickle foot is often accompanied by other malformations. Affected infants then have, for example, deformed big toes or a flattened metatarsus. This can lead to malpositions and, as a result, to joint wear and tear, which is associated with pain and further restrictions on movement.
A sickle foot can therefore primarily be recognized by its external features. The congenital form persists throughout life, usually with no deterioration in health. Early treatment can effectively eliminate the symptoms.
Diagnosis & History
A sickle foot is usually diagnosed on the basis of the visible, typical malposition of the foot or feet. If a hallux varus has developed, this usually indicates a congenital sickle foot.
The fact that the foot is directed straight ahead when stroking over the outer edge of the foot also speaks for the diagnosis of a sickle foot. If the degree of severity of a sickle foot is to be determined, an X-ray examination is suitable. In the vast majority of those affected, a sickle foot regresses on its own in the course of physical development.
In the remaining cases, the treatment prognosis is usually good. In a few untreated cases, a sickle foot can lead to pain, osteoarthritis and restricted movement in the long term.
In rare cases, untreated sickle foot can cause complications. Due to the permanent deformity of the foot, there is a risk that the metatarsal will stiffen. In addition, the ankle, knee and hip joints wear out, causing permanent damage to the articular cartilage. Bone damage occurs at the same time – arthrosis occurs and thus permanent restriction of movement.
For many of those affected, the changed gait is also a cosmetic flaw that is perceived as unpleasant. In the long term, a misalignment can cause psychological problems such as inferiority complexes or exacerbate existing conditions. Surgery can cause the typical complications: bleeding, infection and nerve damage. The joint capsules, which can be damaged during the operation, are particularly at risk.
This leads to sensory disturbances and, in rare cases, permanent movement restrictions. Wound healing disorders and inflammation can occur after the operation. Occasionally, a malposition occurs again, which has to be treated surgically again. Prescribed painkillers and anti-inflammatory drugs can cause gastrointestinal complaints, headaches, muscle and body aches and a number of other side effects and interactions. Allergic reactions to the agents and materials used cannot be ruled out either.
When should you go to the doctor?
A sickle foot should always be treated by a doctor. In the worst case, this can lead to significant complications and limitations in the life of those affected, which can have a very negative effect on their quality of life. For this reason, a sickle foot should be treated at the first sign. Self-healing cannot occur with this disease. A doctor should be consulted if the person concerned suffers from a significant deformity of the foot. The heel is not pointing all the way forward, which can lead to severe pain in the feet.
As a rule, this pain occurs primarily during running, although it can also appear in the form of pain at rest. If you experience these symptoms, you should see a doctor immediately. Severe limitations in movement also indicate a sickle foot and should also be checked by a doctor. Especially in children, parents need to pay attention to the symptoms of this disease and then consult a doctor. As a rule, a sickle foot can be diagnosed and treated by an orthopedist.
Treatment & Therapy
In many cases, a sickle foot does not require medical treatment. However, if a therapeutic measure is necessary, this often consists of a manual correction of the sickle foot in the infant; if only the forefoot is affected by a sickle foot, repeated pressing of the affected foot into the normal position can remedy the sickle foot.
Repeated stroking of the outer edge of the foot can also contribute to normal alignment of the sickle foot. Foam rings that are attached to the lower legs of an infant affected by sickle foot can also provide therapeutic support: With the help of the foam rings in the prone position, it is possible to prevent the infant’s feet from lying with their outer edges on the surface.
More far-reaching therapeutic steps may be necessary if the metatarsal is also affected by sickle foot in addition to the forefoot. In this case, for example, plaster casts are applied to the thighs for a period of about one to three weeks, which are finally replaced by so-called positioning shells to be worn at night. If affected children then walk and stand, special shoe inserts can be used to correct the sickle foot. In a few cases, surgical interventions may be necessary to correct a sickle foot.
If a sickle foot is hereditary, its development cannot usually be prevented. Avoiding foot rotation in a prone infant may help prevent acquired sickle foot. If the first signs of sickle foot appear, it may make sense to seek medical advice; if necessary, measures against sickle foot can be taken at an early stage.
If sickle foot is diagnosed in a newborn, treatment is not always necessary, as spontaneous correction often takes place during growth. If non-surgical therapies such as special splints, wraps or orthopedic shoes are unsuccessful, the position-related deformity can be corrected with a surgical procedure. Plaster casts are also applied to bring the foot back to its central position. In the pre- and post-operative care, dimensionally stable positioning splints serve as a comfortable plaster substitute. After an operation or after plaster therapy, intensive follow-up treatment with physiotherapeutic procedures is necessary. Special stretching and strengthening exercises are carried out to stabilize the foot position. Physiotherapy is useful even for infants,
The physiotherapist treats the deformity of the baby’s foot with stroking massages that strengthen the foot muscles and mobilize the toes. During the sickle foot follow-up treatment, the parents can continue to do professionally instructed exercises for stretching the feet independently at home. Regular medical check-ups are necessary, especially in the case of surgically treated deformities, but also to ensure the success of conservative therapy measures.
Orthopedic shoe inserts serve to maintain the success of the treatment over the long term. Anti-varus shoes are also used as a supplementary measure to successful physiotherapeutic aftercare. The health insurance companies bear the main costs for these stable shoes, provided that an orthopedic diagnosis is available. A slightly pronounced sickle foot that is noticed later should always be examined by a doctor.
You can do that yourself
Experience has shown that the sickle foot recedes on its own as it grows. A medical diagnosis is still urgently needed – just to document the progress of the individual measures.
Parents can support healing through massage. It is advisable to first practice the corresponding movements under the supervision of a therapist. The muscles are gently brought into the ideal position. The elasticity of the foot on the inner edge is decisive for success. For older children, exercises with a soccer ball are worthwhile. Kicking with the inside in particular supports the healing process and is a lot of fun.
Sickle foot is a serious anomaly. The condition should therefore never be treated exclusively by laypersons. Otherwise there is a risk of a lifelong disability with the resulting professional and private restrictions. Young adolescents can be supported by massages and exercise units. A combination of therapy and self-measures promises the best success.
In the event of complications, doctors try to correct the misalignment with plaster casts and an operation. If this is not completely successful, shoes with insoles often have to be used. Pain and pressure points after longer distances characterize everyday life.