Is the Apert foot an overlooked aspect of this rare genetic disease? Clinical findings and treatment options for foot deformities in Apert syndrome

摘要

Left and right foot of a 3-year old boy with Apert’s syndrome showing complex syndactyly of toes 2 to 4, as well as a shortened and medially deviating great toe as a typical deformity (a). Pedobarography of a 4-year-old boy with Apert’s syndrome. Pressure distribution shows a shift laterally, with the maximum weight bearing along the metatarsals 3 and 4 on the left foot (84,7 N/cm3). The right foot shows a similar shift of the pressure points, the maximum is on the third metatarsal with a smaller weight bearing area (95 N/cm3) (b). Images of a 6-month old child with an interposed additional ray are shown. At the age of 4 years one can depict the calcaneocuboidal fusion, a synchondrosis between the metatarsal III base and the distal tarsals as well as an ossification between the great toe and the second toe. The final image after surgery 2 years postoperatively is shown. The additional full ray was resected, and a metatarsal II elevation osteotomy was performed to reduce the plantar pressure below it (c). Images of another case, 1 year and then 5 years of age, reveals an osseous bridge between metatarsal I and II, marked shortening of the first ray and mild hallux varus. A gradual lengthening procedure was performed to elongate the shortened ray (d). Images of a case (Blauth type III) with complete syndactylies I-V and forefoot adductus are shown. The radiographs show marked forefoot adduction partially caused by an interposed supernumerary dysplastic ray. Following resection of this ray the forefoot position and shape was markedly improved (e)