Clubfoot, also known as talipes equinovarus, is a congenital deformity of the foot that occurs in about 1 in 1,000 births in the United States. The affected foot tends to be smaller than normal, with the heel pointing downward and the forefoot turning inward. The heel cord [achilles tendon] is tight, causing the heel to be drawn up toward the leg. This position is referred to as “equinus,” and it is impossible to place the foot flat on the ground. Since the condition starts in the first trimester of pregnancy, the deformity is often quite rigid at birth.
The three classic signs of clubfeet are
- Fixed plantar flexion (equinus) of the ankle, characterized by the drawn up position of the heel and inability to bring to foot to a plantigrade (flat) standing position. This is caused by a tight achilles tendon
- Adduction (varus), or turning in of the heel or hindfoot
- Adduction (turning under) of the forefoot and midfoot giving the foot a kidney-shaped appearance
- calcaneovalgus (congenital calcaneovalgus) refers to flexible flatfoot in infants and young children;
- frequently seen infant foot disorder w/ forefoot abducted and the ankle severely dorsiflexed;
- mild form may be seen in upto 30% of infants but a more severe form is present in 1/000 infants
- common disorder presummed to be a result of intra uterine positioning, muscle imbalance
- occurs as a result of flaccid paralysis or weakness of the plantarflexors;
- MECHANICAL THEORY: the raised intrauterine pressure forces the foot against the wall of the uterus in the position of deformity.
- ISCHAEMIC THEORY: ischaemia of the calf muscles during intra-uterine life, due to some unknown factors, results in contracture leading to foot deformity.
- GENETIC THEORY: some genetically related disturbances of the foot results in the deformity.
PARALYTIC DISORDERS: in a case where there is a muscle imbalance i.e the invertors and the plantar flexors are stronger than the evertors and the dorsiflexors, an equino-varus deformity will result
this occurs in paralytic disorders such as:
- Spina bifida
- Freidreich’s ataxia
ARTHOGRYPOSIS MULTIPLEX CONGENITA(AMC): this is disorder of defective development of muscles the muscles are fibrotic and results in foot deformities, and deformities at other joints.
FOOT EXAMINATION: normally the foot of the newborn child can be dorsiflexed until the dorsum touches the anterior aspect of the shin of the tibia. This is good screening test to check the milder variety of clubfoot. The more classic one will have the following findings:
- Bilateral foot deformity
- Size of foot is smaller
- The foot is in eqinus, varus and adduction and cavus
- The heel is small in size the calcaneum can be left with great difficulty
- Deep skin creases on the back of the heel nad on the medial side of the sole.
- Bony prominences felt on the lateral side of the foot the head of talus and lateral malleolus
- The outer side of the foot is gently convex. There are dimples on the outer side of the ankle
On attempted correction one can feel the tight structures posteriorly (tendo-achilles) and plantarwards (plantar fascia).
A child presenting late may have callosities over the lateral aspect of the foot. The calf muscles are wasted.
GENERAL EXAMINATION: it is aimed at detecting a possible cause. A patient of polio may have muscle of some other part paralysed. An associated sensory deficit point to an underlying neurological cause.the presence of deformities at other joint may indicatearthrogyposis multiplex congenita.(AMC)
RAGIOLOGICAL EXAMINATION: X-RAY of the foot are done (anterior-posterior and lateral.) with the foot in whatever corrected position possible. The talo-calcaneal angles in both AP and lateral views in a normal foot is more than 35 degrees.but in ctev these are reduced.
PRINCIPLE OF TREATMENT:
The treatment consist of correction of deformity by non-operative or operative methods, followed by maintainence of the foot in the corrected position. This is continued until the foot grows to a reasonable size so that the deformity does not occur. treatment should be started as early as possible.
NON OPERATIVE METHODS:
- MANIPULATION ALONE
- MANIPULATION AND STRAPPING OR CORRECTIVE PLASTER CAST
- POSTERIOR-MEDIAL SOFT TISSUE RELEASE
- LIMITED SOFT TISSUE RELEASE
- TENDON TRANSFERS
- DWYER’S OSTEOTOMY
- DILWYN-EVANS PROCEDURE
- WEDGE TARSECTOMY
- TRIPLE ARTHRODESIS
- ILIZAROV’S TECHNIQUE
METHODS OF MAINTAINENCE OF CORRECTION:
- CTEV SPLINTS
- DENIS-BROWN SPLINT
- CTEV SHOES
At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:
- Pain relief
- Reduce stiffness
- Relieve spasm
- Muscle strengthening
- Prescription of splint.
- Foot wear modification
VISIT PHYSIOLINE FOR FURTHER CONSULTATION AND TREATMENT.