{"id":5065,"date":"2025-05-18T19:54:33","date_gmt":"2025-05-18T17:54:33","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=5065"},"modified":"2025-05-19T10:04:01","modified_gmt":"2025-05-19T08:04:01","slug":"malposition-du-pied","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=5065","title":{"rendered":"R\u00e9\u00e9ducation du pied du nourrisson &#8211; G\u00e9n\u00e9ralit\u00e9s"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Rappels anatomiques<\/h2>\n\n\n\n<p>Angle de divergence talo-calcan\u00e9en<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"365\" height=\"487\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-43.avif\" alt=\"\" class=\"wp-image-5067\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-43.avif 365w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-43-225x300.avif 225w\" sizes=\"auto, (max-width: 365px) 100vw, 365px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"89\" height=\"199\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-42.avif\" alt=\"\" class=\"wp-image-5066\" style=\"width:161px;height:auto\"\/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"302\" height=\"167\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-44.avif\" alt=\"\" class=\"wp-image-5068\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-44.avif 302w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-44-300x166.avif 300w\" sizes=\"auto, (max-width: 302px) 100vw, 302px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Rappels sur les ossifications<\/h3>\n\n\n\n<p>Le pied est cartilagineux chez l&rsquo;enfant, donc fragile. Il y a une ossification progressive :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Talus : \u00e0 la naissance<\/li>\n\n\n\n<li>Calcan\u00e9um : \u00e0 la naissance<br>Cubo\u00efde : 0 \u00e0 4 mois<br>M\u00e9tatarses et Phalanges : Diaphyses \u00e0 la naissance, \u00e9piphyses entre 3 et 5 ans.<br>Cun\u00e9iforme 1 :12 \u00e0 25 mois<br>Cun\u00e9iforme 2 : 20 \u00e0 48 mois<br>Cun\u00e9iforme 3 : 1\u00e0 7 mois<br>Naviculaire : 5 ans<br>Apophyse post\u00e9rieure du calcan\u00e9um : 8 ans<br>Le pied n\u2019est totalement ossifi\u00e9 que vers 9 ans.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Rappels muscles et apon\u00e9vrose<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tibial ant.<br>Tibial post.<br>Triceps sural<br>Extenseurs, fl\u00e9chisseurs des orteils<br>ABD de l\u2019hallux (important chez les enfants)<br>Fibulaires<br>Carr\u00e9 plantaire\u2026<br>Apon\u00e9vrose : r\u00e9tract\u00e9 (pied bot) \/ distendu (pied plat)<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Principes g\u00e9n\u00e9raux de prise en charge<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Traitement \u00e0 la carte<br>Connaissance de l\u2019enfant<br>Respect de la maturation psychomotrice<br>Respect de la maquette cartilagineuse<br>Respect de la non douleur<\/li>\n\n\n\n<li>Enfant, parents \/ entourage, \u00e9quipe m\u00e9dicale (coop\u00e9ration, concertation, libre choix des techniques)<br>Associer l\u2019enfant \u00e0 son traitement = \u00ab le b\u00e9b\u00e9 est une personne \u00bb<\/li>\n<\/ul>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>\u00abLaisser un pied partiellement d\u00e9vi\u00e9, n&rsquo;est pas une faute. Mais le corriger faussement, par certains remaniements, cr\u00e9e une pathologie iatrog\u00e8ne qu&rsquo;il est difficile, voire impossible \u00e0 rattraper.\u00bb Andr\u00e9 Guillaume<\/p>\n<\/blockquote>\n\n\n\n<h3 class=\"wp-block-heading\">Relation avec l&rsquo;enfant<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>S\u2019adapter, communiquer<br>Le conna\u00eetre et le comprendre (cris, pleurs, r\u00e9actions)<br>Le respecter, obtenir sa confiance<\/li>\n\n\n\n<li>Sch\u00e9mas cin\u00e9tiques de l\u2019enfant = <strong>connaissance<\/strong> (adaptation du TTT) et <strong>respect<\/strong> (TTT en harmonie avec l\u2019enfant)<\/li>\n\n\n\n<li>R\u00f4les des parents = rassurer, s\u00e9curiser, expliquer, responsabiliser<br>Chanter est une bonne fa\u00e7on de communiquer avec les enfants<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9veloppement psychomoteur de l&rsquo;enfant<\/h3>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>0 &#8211; 6 semaines<\/strong> <\/td><td>&#8211; Sch\u00e9ma de triple flexion (activit\u00e9 dominante des muscles F hanche, genou, pied)<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"59\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-46.avif\" alt=\"\" class=\"wp-image-5078\" style=\"width:112px;height:auto\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>6 &#8211; 20 semaines<\/strong> <\/td><td>&#8211; Passage progressif vers le sch\u00e9ma d\u2019extension<br>&#8211; Palier maximum entre la 12e et 16e semaine (puis va en d\u00e9croissant)<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"112\" height=\"84\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-47.avif\" alt=\"\" class=\"wp-image-5079\" style=\"width:204px;height:auto\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Vers 5e mois<\/strong><\/td><td>&#8211; \u00c9quilibration entre sch\u00e9ma extension et flexion<br>&#8211; L\u2019enfant cherche \u00e0 se retourner = sollicitation musculature <strong>varisante<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"168\" height=\"74\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-48.avif\" alt=\"\" class=\"wp-image-5082\" style=\"width:277px;height:auto\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Vers 8e mois<\/strong><\/td><td>L\u2019enfant cherche \u00e0 se mettre debout<br>Pied = appui presque en permanence sur l\u2019avant pied (digitigrade)<br>R\u00e9apparition du sch\u00e9ma d\u2019extension<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"101\" height=\"92\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-50.avif\" alt=\"\" class=\"wp-image-5086\" style=\"width:221px;height:auto\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Vers 9e\/10e mois<\/strong><\/td><td>Baisse du tonus<br>P\u00e9riode du ramper et de la quadrup\u00e9die<br>ATTENTION : 10mois est la p\u00e9riode d\u2019inqui\u00e9tude max pour l\u2019enfant<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"107\" height=\"96\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-51.avif\" alt=\"\" class=\"wp-image-5087\" style=\"width:169px;height:auto\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Puis progressivement :<\/strong><\/td><td>&#8211; Enfant cherche \u00e0 nouveau la position verticale, mise debout, marche<br>&#8211; De nouveau il y a une pr\u00e9dominance du sch\u00e9ma d\u2019extension<br>&#8211; En moyenne = marche vers 14 \/ 15 mois<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"121\" height=\"107\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/05\/image-52.avif\" alt=\"\" class=\"wp-image-5088\" style=\"width:218px;height:auto\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<p>Les parents<\/p>\n\n\n\n<p>Leur r\u00f4le est de<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rassurer<\/li>\n\n\n\n<li>S\u00e9curiser<\/li>\n\n\n\n<li>Expliquer en quoi consiste la pathologie<\/li>\n\n\n\n<li>Responsabiliser : respecter l&rsquo;appareillage<\/li>\n<\/ul>\n\n\n\n<p>Exigence du kin\u00e9<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ne pas coucher l&rsquo;enfant sur le ventre : risque de mort inattendue du nourrisson (Important : <a href=\"https:\/\/www.chu-lyon.fr\/sites\/default\/files\/livret-prevention-min-hfme-hcl.pdf\">pr\u00e9vention de la mort inattendue du nourrisson par le CHU de Lyon<\/a>)<\/li>\n\n\n\n<li>Participer \u00e0 la s\u00e9ance en calmant et apaisant l&rsquo;enfant : donner le biberon avant ou pendant la s\u00e9ance<\/li>\n\n\n\n<li>Ne jamais \u00f4ter l&rsquo;appareillage, sauf autorisation du praticien<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Examen clinique du pied<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Taille du pied \u00e0 la naissance : 5 \u00e0 7 cm<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Palpation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Palpation mall\u00e9olaire<\/li>\n\n\n\n<li>Appr\u00e9ciation de l&rsquo;axe bimall\u00e9olaire<\/li>\n\n\n\n<li>Palpation du calcan\u00e9um et de la coque talonni\u00e8re (pied \u00e0 angle droit)<\/li>\n\n\n\n<li>Appr\u00e9ciation de l&rsquo;axe du tendon tricipital<\/li>\n\n\n\n<li>Recherche d&rsquo;une saillie de la t\u00eate du talus, du naviculaire ou de la stylo\u00efde du Ve m\u00e9tatarsien<\/li>\n\n\n\n<li>Palpation de la vo\u00fbte plantaire \u00e0 la recherche d&rsquo;un cavus m\u00e9dio-tarsien<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Dynamique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recherche griffe des orteils<\/li>\n\n\n\n<li>V\u00e9rification des amplitudes articulaires : FD\/FP, ADD\/ABD, prono-supination<\/li>\n\n\n\n<li>Recherche activit\u00e9 des fl\u00e9chisseurs des orteils par une pression sous la t\u00eate du 1et et 2e mat\u00e9tarse<\/li>\n\n\n\n<li>Recherche activit\u00e9 du tibial ant\u00e9rieur et post\u00e9rieur par une position du MI en sch\u00e9ma varisant et en exer\u00e7ant de petites pressions r\u00e9p\u00e9t\u00e9es au niveau du naviculaire ou de la t\u00eate du 1er m\u00e9ta<\/li>\n\n\n\n<li>Recherche activit\u00e9 des fibulaires en exer\u00e7ant des stimulations sur le bord externe du pied<\/li>\n\n\n\n<li>Recherche d&rsquo;activit\u00e9 des extenseurs communs des orteils par des stimulations sur la face dorsale du pied<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Cl\u00e9s d&rsquo;une s\u00e9ance r\u00e9ussie<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pi\u00e8ce calme et silencieuse<br>Lumi\u00e8re non agressive<br>Installation confortable de l\u2019enfant<br>Enfant propre et rassasi\u00e9 ou repas durant la s\u00e9ance<br>Installation confortable du th\u00e9rapeute<br>Concentration du th\u00e9rapeute<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Les mobilisations<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gestes pr\u00e9cis et r\u00e9guliers<br>Pressions bien dos\u00e9es<br>\u00c9tirement, d\u00e9coaptation<br>Contact permanent<br>Ordre des manoeuvres pr\u00e9cis et suivi<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">L&rsquo;appareillage<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Efficacit\u00e9 manuelle du kin\u00e9sith\u00e9rapeute<br>Hypo-correctif<br>Limiter les contraintes pour l\u2019enfant<br>Adapter la contention en fonction de l\u2019enfant et de l\u2019effet recherch\u00e9<br>Respecter la fonction de la talo-crurale<br>Privil\u00e9gier l\u2019information et le conseil aux familles<br>Surveiller l\u2019\u00e9tat cutan\u00e9 du pied<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Cons\u00e9quences d&rsquo;un appareillage inadapt\u00e9<\/h3>\n\n\n\n<p>L&rsquo;hypercorrection peut entra\u00eener :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Des cons\u00e9quences au niveau des zones cartilagineuses qui sont tr\u00e8s fragiles: aplatissement du d\u00f4me du talus, aplatissement du rebord ant\u00e9rieur du tibia, l\u00e9sion de la mall\u00e9ole externe.<br>Des fausses corrections, difficilement r\u00e9ductibles, m\u00eame par le chirurgien: rupture partielle ou totale de l&rsquo;articulation m\u00e9dio-tarsienne, rotation exag\u00e9r\u00e9e de la pince bimall\u00e9olaire\u2026<br>Des r\u00e9actions de d\u00e9fense de l\u2019enfant : D\u00e9s\u00e9quilibres musculaires, aggravation des diff\u00e9rentes r\u00e9tractions existantes (Triceps, cavus de l&rsquo;avant-pied, griffe des orteils).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Rappels anatomiques Angle de divergence talo-calcan\u00e9en Rappels sur les ossifications Le pied est cartilagineux chez l&rsquo;enfant, donc fragile. Il y a une ossification progressive : Rappels muscles et apon\u00e9vrose Principes g\u00e9n\u00e9raux de prise en charge&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=5065\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0R\u00e9\u00e9ducation du pied du nourrisson &#8211; G\u00e9n\u00e9ralit\u00e9s\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[376],"tags":[],"class_list":["post-5065","post","type-post","status-publish","format-standard","hentry","category-champ-pediatrie"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5065","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5065"}],"version-history":[{"count":15,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5065\/revisions"}],"predecessor-version":[{"id":5103,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5065\/revisions\/5103"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5065"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5065"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5065"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}