title: A rare pentad of foot and ankle deformities in hyperlax children.
abstract: OBJECTIVE
  The aim of this paper is to describe the clinical features and radiological appearance of a rare and complex lower leg and foot deformity in hyperlax children.
  
  
  METHODS
  Four children were included in the study; of these, two had bilateral feet involvement. All deformities were present since birth, comprising a pentad of conditions: (1) pathologic external tibia and fibula torsion, (2) ball and socket ankle joint with medial subluxation and talus medial subluxation, (3) excessive hindfoot valgus, (4) peroneal and Achilles tendon displacement anterior to the lateral malleolus and (5) generalized ligament laxity. All children had failed cast manipulation. Only two had undergone a minimal soft tissue procedure, but there had been no improvement.
  
  
  RESULTS
  All patients were ambulatory and pain free at the mean age of 6.5 years.
  
  
  CONCLUSIONS
  Conservative or minimal soft tissue procedures are not effective in restoring the anatomy of such feet.
authors.affiliation: King Faisal Specialist Hospital and Research Center, MBC-77, P.O. Box 3354, Riyadh, 11211, Saudi Arabia, imran_ilyas@hotmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Ilyas
authors.forename: W J
authors.initials: WJ
authors.lastname: Wade
authors.forename: M
authors.initials: M
authors.lastname: Al Barrag
authors.forename: T S
authors.initials: TS
authors.lastname: Al Hussainan
authors.forename: L A
authors.initials: LA
authors.lastname: Lotaibi
authors.forename: M
authors.initials: M
authors.lastname: Alssayad