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Club FeetClub FeetJananthan, Sandareka & SharmilaJananthan, Sandareka & Sharmila

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What is clubfoot?What is clubfoot?

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

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

births and affects boys twice as often as births and affects boys twice as often as girls. girls.

Fifty percent of clubfoot cases affect both Fifty percent of clubfoot cases affect both feet.feet.

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Cause?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.

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Types of Club FootTypes 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…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.

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Types of Club Foot…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.

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Types of Club Foot…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…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 non-surgical 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.

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DiagnosisDiagnosis

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…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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TreatmentTreatment

Treatment for any kind of clubfoot is started Treatment for any kind of clubfoot is started as soon as possible after birth. The goal of as soon as possible after birth. The goal of treatment is to obtain a lasting correction treatment is to obtain a lasting correction and a foot that is functional and and a foot that is functional and cosmetically acceptable. cosmetically acceptable.

Treatment goals also should include making Treatment goals also should include making the maximum attempt to maintain the maximum attempt to maintain normalcy in the lives of the patient and the normalcy in the lives of the patient and the patient's family. patient's family.

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Treatment TypesTreatment Types ManipulationManipulation ExerciseExercise SurgerySurgery

To maintain the correction, following To maintain the correction, following method can be usemethod can be use

Plaster CastPlaster CastOrthosis / SplintOrthosis / SplintBandaging Bandaging

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Serial CastingSerial Casting

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

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Serial Casting…Serial Casting…

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

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

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Serial Casting…(Serial Casting…(Ponseti Method)

Does the Ponseti method always work?Does the Ponseti method always work?

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

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SurgerySurgery

There are two minimal surgeries that may be There are two minimal surgeries that may be required:required:

1.1. TenotomyTenotomy (needed in 80% of cases) is a (needed in 80% of cases) is a release (clipping) of the Achilles tendon - release (clipping) of the Achilles tendon - minor surgery- local anesthesia.minor surgery- local anesthesia.

2.2. Anterior Tibial Tendon Transfer (needed Anterior Tibial Tendon Transfer (needed in 20% of cases) - where the tendon is in 20% of cases) - where the tendon is moved from the first ray (toe) to the third moved from the first ray (toe) to the third ray in order to release the inward traction ray in order to release the inward traction on the foot. on the foot.

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Surgery…Surgery…

Extensive Surgery & Complications:Extensive Surgery & Complications:

May lead to scar tissue developing inside May lead to scar tissue developing inside the child's foot.the child's foot.

May result in functional, growth and May result in functional, growth and aesthetic problems in the foot.aesthetic problems in the foot.

May require on average 2 additional May require on average 2 additional surgeries to correct the issues mentioned. surgeries to correct the issues mentioned.

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Orthotic ManagementOrthotic Management To maintain the Corrected position of the To maintain the Corrected position of the

Manipulation.Manipulation.

To maintain the correction done by To maintain the correction done by surgery. surgery.

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Orthotic OptionsOrthotic Options

Dennis Brown splintDennis Brown splintThe splint is set at 60 to 70The splint is set at 60 to 70ºº of external of external rotation, and 50rotation, and 50ºº Dorsiflexion. Dorsiflexion.

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Orthotic Options…Orthotic Options…

Ankle Foot OrthosisAnkle Foot OrthosisIt can be used if the deformity is already It can be used if the deformity is already reduced, and the child needs to walk.reduced, and the child needs to walk.

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Orthotic Options…Orthotic Options…

Knee Ankle foot Orthosis set in Knee Ankle foot Orthosis set in 90deg knee Flexion90deg knee FlexionMaintain the foot abducted Maintain the foot abducted and externally rotated. 90and externally rotated. 90ºº knee flexion position to knee flexion position to reduce the tension of reduce the tension of gastrocnemius, which make gastrocnemius, which make easy to correct the equinus.easy to correct the equinus.

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Complications Complications

Fix deformity of Talipes Equino Varus.Fix deformity of Talipes Equino Varus.

Patient walk with lateral border of foot Patient walk with lateral border of foot touching the ground touching the ground

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Orthotic Treatment Orthotic Treatment post complicationpost complication

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

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That’s it! Thanks That’s it! Thanks for your for your

attention…attention…

Are there any questions?Are there any questions?

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ReferencesReferenceshttp://www.kuspito.co.cc/2009/02/orthotic-management-of-http://www.kuspito.co.cc/2009/02/orthotic-management-of-

club-foot.htmlclub-foot.html

http://www.oandp.org/jpo/library/1995_03_091.asphttp://www.oandp.org/jpo/library/1995_03_091.asp

http://en.wikipedia.org/wiki/Club_foothttp://en.wikipedia.org/wiki/Club_foot

http://www.orthomerica.com/products/anklefoot/ankle_foot.htmhttp://www.orthomerica.com/products/anklefoot/ankle_foot.htm

http://orthopedics.about.com/cs/pediatricsurgery/a/http://orthopedics.about.com/cs/pediatricsurgery/a/clubfoot.htmclubfoot.htm

http://www.jandjartificiallimbandbrace.com/page4.htmlhttp://www.jandjartificiallimbandbrace.com/page4.html