Clubfoot

Answer 1

What is Clubfoot?

Clubfoot describes a group of foot abnormalities ,in which your baby's foot is twisted in.

The tendons ( tissues connecting muscles to bone ) are shorter than usual.

Clubfoot is the most common birth defect.

• 1:1,000
• highest prevalence in Hawaiians and Maoris
• male:female ratio approximately 2:1
• Anatomic location
• 50%of cases are bilateral

Epidemiology

• Associated conditions
  • arthrogryposis
  • diastrophic dysplasia
  • myelodysplasia
  • tibial hemimelia
  • amniotic band syndrome (Streeter dysplasia)
  • upper extremity and hand anomalies common in this population
  • Pierre Robin syndrome
  • Opitz syndrome
  • Larsen syndrome
  • prune-belly syndrome
  • anterior tibial artery hypoplasia or absence is common, regardless of etiology of clubfoot

Anatomy of Clubfoot?

Muscle contractures contribute to the characteristic deformity that includes (CAVE)

Cavus (tight intrinsics, FHL, FDL)

Adductus of forefoot (tight tibialis posterior)

Varus (tight tendoachilles, tibialis posterior, tibialis anterior)

Equinus (tight tendoachilles)

• Bony deformity consists of medial spin of the midfoot and forefoot relative to the hindfoot
• talar neck is medially and plantarly deviated
• calcaneus is in varus and rotated medially around talus
• navicular and cuboid are displaced medially

Are Club Feet genetic?

• strongly suggested
• unaffected parents with affected child have 2.5% - 6.5% chance of having another child with a clubfoot
• familial occurrence in 25%
• link to PITX1

How are Clubfeet diagnosed?

Ultrasound

• 1st trimester
  • associated anomalies, including non-musculoskeletal
• 2nd trimester
  • true clubfeet
• 3rd trimester
  • false positive rate is higher due to intrauterine crowding

Radiographs

• often not taken
• recommended views, if taken(dorsiflexion lateral (Turco view) AND AP
• CTEV (CLUB FOOT) treatment in Indore , Bhopal , Ujjain , Dewas , Guna

Treatment of Clubfeet?

Ponseti method. Gentle stretching and casting to gradually correct the deformity.

Treatment begins shortly after birth

6-8 weekly plasters needed

Achilles tenotomy. 90 percent of babies will require a minor procedure to release continued tightness in the Achilles tendon (heel cord), managed by Tendo Achilles Tenotomy i.e the tendon is cut. Plaster is then applied for 3 weeks.

Bracing. The brace keeps the foot at the proper angle to maintain the correction. This bracing program can be demanding for parents and families, but is essential to prevent relapses.

For More Details, Please Contact

Dr Gaurav Jain

20 B Sainath Colony , Indore

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Answer 2

Definition

Clubfoot is when the foot turns inward and downward. It is a congenital condition, which means it is present at birth.

Alternative Names

Talipes equinovarus; Talipes

Causes, incidence, and risk factors

Clubfoot is the most common congenital disorder of the legs. It can range from mild and flexible to severe and rigid.

The cause is not known, but the condition may be passed down through families in some cases. Risk factors include a family history of the disorder and being male. The condition occurs in about 1 out of every 1,000 live births.

Symptoms

The physical appearance of the foot may vary. One or both feet may be affected.

The foot turns inward and downward at birth, and is difficult to place in the correct position. The calf muscle and foot may be slightly smaller than normal.

Signs and tests

The disorder is identified during a physical examination. A foot x-ray may be done.

Treatment

Treatment may involve moving the foot into the correct position and using a cast to keep it there. This is often done by an orthopedic specialist. Treatment should be started as early as possible -- ideally, shortly after birth -- when reshaping the foot is easiest.

Gentle stretching and recasting occurs every week to improve the position of the foot. Generally, five to 10 casts are needed. The final cast remains in place for 3 weeks. After the foot is in the correct position, a special brace is worn nearly full time for 3 months. Then it is used at night and during naps for up to 3 years.

Often, a simple outpatient procedure is needed to release a tightened Achilles tendon.

Some severe cases of clubfoot will require surgery if other treatments do not work, or if the problem returns. The child should be monitored by a doctor until the foot is fully grown. See: Clubfoot repair

Expectations (prognosis)

The outcome is usually good with treatment.

Complications

Some defects may not be completely fixed. However, treatment can improve the appearance and function of the foot. Treatment may be less successful if the clubfoot is linked to other birth disorders.

Calling your health care provider

If your child is being treated for clubfoot, call your health care provider if:

• The toes swell, bleed, or change color under the cast
• The cast appears to be causing significant pain
• The toes disappear into the cast
• The cast slides off
• The foot begins to turn in again after treatment

References

Hosalkar HS, Spiegel DA, Davidson RS. The foot and toes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 673.

Beaty JH. Congenital anomalies of the lower extremity. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 26.