Forefoot Adduction (FFA) in Infants and Toddlers. Differences of Neuromuscular Activity.

Every week we encounter with 5-8 pairs of worried parents of infants with forefoot adduction. Most of them usually need only reassurance and education how to manipulate the deformed foot. During the examination we usually use provocative maneuver to trigger peroneal activity. This manual stimulation usually reveals active eversion and dorsiflexion of the foot in most of the children, but not in all of them. Small part of the children reacts in opposite direction - instead of the typical eversion they demonstrate inversion and some plantar flexion of the foot. We have the impression that this subgroup of children improves the deformity slower and sometime less complete than most of the children. We did not find in the literature any description of this phenomenon. We postulate, that atypically reacting patients probably have different response due to abnormalities of neuromuscular balance between invertors-flexors and evertors-extensors muscle groups. This small subgroup of children may need more close follow-up and probably casting to speed up and secure the improvement of their deformity.

Study goals:

1. Evaluate ability of children with FFA to respond on mechanical triggering of peroneal activity

   1. The majority of the patients with standard reaction - foot dorsiflexion and eversion (evertors)
   2. The minority of the patients with nonstandard reaction - foot plantarflexion and inversion (invertors)
2. Evaluate randomly selected children from each group for character of muscular response on electrical stimulation (EMG) of calf muscles.