Club Feet Final

Club Feet Jananthan, Sandareka & Sharmila

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What is clubfoot? Clubfoot, also known as Talipes equinovarus, is a foot deformity combination of varus heel, adducted fore foot, equinus ankle, supination of whole foot, pes cavus and some time internal tibial rotation.

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What is clubfoot?...  It can affect one or both feet.  It occurs in about one in every 1,000 live

births and affects boys twice as often as girls.  Fifty percent of clubfoot cases affect both feet.

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Cause? The cause is unknown, but there are several different theories. Talipes can run in families, some doctors believe that it could be the result of the position or development of the baby in the womb, or very occasionally it may be indicative of a problem that affects the skeletal or nervous systems. 4

Types of Club Foot In pinpointing the specific cause of clubfoot, the condition is classified into four types,congenital, teratologic, syndrome complex, or positional. The four types are determined by the cause as follows:

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Types of Club Foot… 1.

Congenital clubfoot is by far the most common form of clubfoot and is also referred to as "idiopathic" clubfoot, meaning that the condition arises spontaneously from an unknown cause. A child with congenital clubfoot has no other abnormalities, and the clubfoot is an isolated incident. The condition occurs more frequently within certain families, prompting scientists to believe that genetics play an important role in causing congenital clubfoot. 6

Types of Club Foot… 2.

Teratologic clubfoot occurs as a part of an underlying neuromuscular disorder, such as spina bifida or arthrogryposis multiplex congenita. Clubfoot may or may not be present in children with these disorders. Teratologic clubfoot often is severe and nearly always requires early, radical surgery to achieve correction. 7

Types of Club Foot… 3.

Syndrome Complex clubfoot occurs when a child is born with one of a number of genetic disorders, and clubfoot is part of the bigger disorder. Children with chromosomal abnormalities such as Down syndrome may also have Syndrome Complex clubfoot.

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Types of Club Foot… 4.

Positional clubfoot occurs when an otherwise normal foot is held in a deformed position in utero, and thus is "moulded" incorrectly. A small uterus, the presence of twins and abnormal foetal position have all been associated with positional clubfoot, although many such pregnancies result in babies without clubfoot. Positional clubfoot responds readily to nonsurgical treatments, such as splinting and casting. Because positional clubfoot is not an inherent defect, but instead a "packaging" problem, some physicians do not consider it a true clubfoot. 9

Diagnosis Many clubfeet are diagnosed prenatally based on ultrasound. By 24 weeks gestation,about 80% of clubfeet can be diagnosed. There is approximately a 20% false positive ratebased on ultrasound diagnosis, meaning it sometimes appears that a clubfoot is present,when it is not.

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Diagnosis… At the time of birth, clubfoot is diagnosed by physical examination, with the finding of a foot which is in a fixed position, with the foot pointing downward and inward and the inability to bring the foot back into normal position. X-rays, although rarely used, canconfirm the diagnosis.

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Treatment Treatment for any kind of clubfoot is started as soon as possible after birth. The goal of treatment is to obtain a lasting correction and a foot that is functional and cosmetically acceptable. Treatment goals also should include making the maximum attempt to maintain normalcy in the lives of the patient and the patient's family. 12

Treatment Types  Manipulation  Exercise  Surgery

To maintain the correction, following method can be use Plaster Cast Orthosis / Splint Bandaging 13

Serial Casting Shortly after birth, treatment with serial manipulations and plaster casting is begun. The patient is evaluated after undergoing three months of weekly cast changes with more correction attempted at each cast change.

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Serial Casting… This minimally-invasive treat-ment method was developed by Dr. Ignacio Ponseti, a professor emeritus at the University of Iowa.

95 years old and still going strong! Dr. Ponseti applying a cast. 15

Serial Casting…(Ponseti Casting…( Method) Does the Ponseti method always work? Unfortunately, no. In some cases, surgery is needed to correct the position of the clubfoot. Most often this is needed in cases where the child has other developmental problems (such as arthrogryposis) or if the child begins treatment more than a few months after birth.

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Surgery There are two minimal surgeries that may be required: 1. Tenotomy (needed in 80% of cases) is a release (clipping) of the Achilles tendon minor surgery- local anesthesia. 2. Anterior Tibial Tendon Transfer (needed in 20% of cases) - where the tendon is moved from the first ray (toe) to the third ray in order to release the inward traction on the foot. 17

Surgery… Extensive Surgery & Complications: May lead to scar tissue developing inside the child's foot. May result in functional, growth and aesthetic problems in the foot. May require on average 2 additional surgeries to correct the issues mentioned.

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Orthotic Management  To maintain the Corrected position of the

Manipulation.  To maintain the correction done by

surgery.

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Orthotic Options Dennis Brown splint The splint is set at 60 to 70º of external rotation, and 50º Dorsiflexion.

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Orthotic Options… Ankle Foot Orthosis It can be used if the deformity is already reduced, and the child needs to walk.

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Orthotic Options… Knee Ankle foot Orthosis set in 90deg knee Flexion Maintain the foot abducted and externally rotated. 90º knee flexion position to reduce the tension of gastrocnemius, which make easy to correct the equinus. 22

Complications  Fix deformity of Talipes Equino Varus.  Patient walk with lateral border of foot

touching the ground

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Orthotic Treatment post complication Fixed deformity cannot be corrected when it is neglected, the orthotic objectives are to accommodate the deformity and enhance mobility. Ankle Foot Orthosis which provide accommodation to the deformed foot can be prescribe to the patient.

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That’s it! Thanks for your attention… Are there any questions?

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References

http://www.kuspito.co.cc/2009/02/orthotic-management-of-club-foot. http://www.oandp.org/jpo/library/1995_03_091.asp http://en.wikipedia.org/wiki/Club_foot http://www.orthomerica.com/products/anklefoot/ankle_foot.htm http://orthopedics.about.com/cs/pediatricsurgery/a/clubfoot.htm http://www.jandjartificiallimbandbrace.com/page4.html

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