Clubfoot- a child"s condition that we can treat!!!!!!!



Clubfeet a treatable deformity of the feet. 




Clubfoot, also known as talipes equinovarus (TEV).
a)     Is a common foot abnormality, in which the foot points downward and inward?
b)    The condition is present at birth, and involves the foot and lower leg.
c)     It occurs twice as often (2:1) in males than in females.
d)    It may affect one or both feet (50 % are bilateral).
For parents with no family medical history of clubfoot, and no other children with clubfoot, the chance of having a child with clubfoot (random occurrence), is 1 in 1,000.
However, if they already have a child with clubfoot, their future children have a 3% (3 in 100) chance of having the same abnormality.
Parents who had clubfoot themselves have a 20-30% chance of having a child with clubfoot.
Care and management of this is a long process beginning as early as 1 week old and lasting to 4-5 years old or older in some cases.

What are the Signs and Symptoms of Clubfoot?
  • Stiff, rigid, foot of varying degrees.
  • Short and/or tight Achilles tendon (heel cord), with foot pointing downward.
  • The heel is turned in.
  • Deep posterior heel crease; soft, puffy heel pad; wide front foot area and overall smaller foot.





What Causes Clubfoot?

Most causes of clubfeet are unknown (idiopathic).
   The main point to remember is that the mother did nothing to cause this.
However, there is a familial tendency noted (passed down from the biologic family) through genes.

There are also many associated disorders or syndromes such as developmental hip dysplasia, spina bifida, arthrogryposis, or myotonic dystrophy.
This foot abnormality can be presented with several different pre-disposing factors
  • Extrinsic: This type is usually mild and supple. The cause can be due to intrauterine compression (large baby, abnormally shaped or small uterus, or abnormal intrauterine fluid levels).

  • Intrinsic: This type is commonly more severe, rigid and the calf muscle is smaller. The foot may be smaller and there can be a bone deformity of the talus.
How is Clubfoot Diagnosed?
  • Many times, the diagnosis of clubfoot can be noted during a prenatal ultrasound. The severity of it cannot be determined until after the child is examined and there is no treatment until after the child is born.

How is Clubfoot Treated?

Over the last century, advances have been made in non-operative treatments, such as casting and bracing as well in surgical techniques.
Current treatment consists of casting and bracing or a combination of casting, bracing and surgery.

Dr. Ignacio Ponseti developed the Ponseti method for treatment of clubfeet over 60 years ago. Today, we begin serial casting in most patients, using the “Ponseti method”, as soon as possible after birth or as early as the child and family are available for examination and treatment.
The success of treatment depends on the overall flexibility of the foot and parents’ compliance with appointments for casting and brace wear for 4 years or so.
  • The bones in a newborn foot are mostly cartilage (soft bones), therefore they are easily moldable/manipulated.
  • We use the casting to slowly stretch the tissues (muscles and ligaments and tendons) and move the foot into correct position.
  • This set of long leg casts requires weekly visits to the clinic to change the foot position in an orderly method.
  • There are typically 3-6 casts required to complete the process.
  • Infants will need to be sponge bathed during this time.
  • This process will not affect how they are transported in car seats.
  • 80 to 90% of patients with clubfeet, (not associated with other conditions), that are treated with the Ponseti technique, will need a small surgery (tenotomy).
  • 10 to 20% of patients will require reconstructive foot surgery when the child is 1-2 years old. This number can be as high as 40%-50% if the shoes and bar are not used for a full 4 years after casting.
                                      Stages in the correction of the foot
                  
                        
Steenbeek foot abduction brace for maintainance

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