By N. Tuwas. Texas A&M University, Commerce.

Surgical treatment is therefore strongly discouraged generic 10mg prednisone overnight delivery, because the risk of com- ⊡ Table 3 buy cheap prednisone 20mg online. Postoperatively, it is not possible to keep the result- Type Features ing web space as dry as one between the fingers, ultimately leading to potential wound adhesions and scar formation, I 2nd–4th toes missing, normal metatarsals which can then (in contrast with the original syndactyly) II 2nd–4th toes missing, all metatarsals present, but cause functional problems (⊡ Fig. The defect is always greater at the distal end compared to An increased frequency of valgus deformity of the distal the proximal end. Occasionally, synostoses are found at femur has also been observed. Clinical features, diagnosis Clinical features, diagnosis While a congenital ball-and-socket ankle joint does not The diagnosis of split foot is easy and always apparent usually produce any symptoms, it can lead to lateral just from the outward appearance (⊡ Fig. The type instability and thus an increased incidence of supination- of split foot can be classified with the aid of an x-ray. Together with the loss of mobility in the further diagnostic investigation is required. In functional subtalar joint, this can lead to premature osteoarthritis in respects, split feet are usually very efficient since the rays the ball-shaped ankle joint. The latter has a characteristic that bear the main weight, 1 and 5, are invariably present appearance on the x-ray (⊡ Fig. The distal ends of the tibia and fibula have Treatment adapted themselves to this shape. In some cases the split feet may be so wide that shoes Treatment cannot be fitted. Occasionally, other complex is based on the tarsal coalition ( Chapter 3. If sub- corrections must be performed or interfering elements stantial symptoms are present and if osteoarthritis devel- removed. In general, however, such indications are rare ops, an arthrodesis may be necessary in adulthood. Of course, the cosmetic appearance is always un- satisfactory, but this cannot really be improved without substantial effort. Occurrence This is a very rare deformity, and the author is not aware of an epidemiological study. The anomaly appears to be slightly more common in Japan and is usually associ- ated with tarsal coalition [5, 22, 47], although it may also be accompanied by other foot deformities. Etiology If tarsal coalition is present, the development of the upper ankle as a ball-and-socket joint is a secondary phenom- enon [5, 22, 47]. The loss of mobility in the lower ankle leads to a secondary change in the upper ankle: instead of just being able to move in one axis of movement, it acquires the ability, over time, to move in 2 axes, as has been confirmed by the findings on x-rays recorded from birth to early childhood [5, 22, 47].

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