Clubfoot

CLUBFOOT

Clubfoot

DEFINITION- Talipes deformity is a disorder of ankle and

foot.  It comes from the Latin words talus meaning ankle and pes meaning foot.

-a congenital anomaly occurring at approximately 1 to 2 in every 1000 live births.

-Male-female incidence ratio is 2:1.

TRUE TALIPES DISORDER

Talipes deformity could either be unilateral (affecting a single foot only) or bilateral (both feet are affected).  Regardless of which extremity is affected, some newborns have developed a twisted foot appearance due to intrauterine position. However, with manipulation the foot can be brought into a straight position.

SIGNS AND SYMPTOMS

Twisted foot appearance should be assessed and gently manipulated. If the straightened foot does not move to a normal

position, true clubfoot is present.

PSEUDO-TALIPES DISORDER temporary abnormality Can be aligned by manipulation

CAUSES

1. Genetic factor

2. Abnormal tendon insertion

Anomalous tendons may affect the alignment of the foot.

3. Retracting fibrosis (myofibrosis)

Collagen found in all ligaments and tendons are coiled and could be stretched with the exception of Achilles tendon (made up of tightly coiled collagen and cannot be stretched).Thickening and scarring of fibrous tissue could cause the twisted foot appearance.

PATHOPHYSIOLOGY Foot is plantar flexed at the ankle and

subtalar joints Hind foot is inverted Midfoot and forefoot are adducted and

inverted contrax

4. Neurogenic factorsInnervation changes during the prenatal period could be due to the presence of neurologic events or disorder such as, spina bifida. Studies show that 35% of children with clubfoot have neurologic impairment.

5. OligohydramniosFluid leak during the prenatal period could cause restriction of fetal movements thereby, predisposing to a deformed foot.

6. Developmental arrest of fetal developmentDisruption of the medial rotation of the fetal foot could result to a clubfoot condition.

7. Diminished Vascular CirculationDisruption of the branches of the vascular supply of the lower extremity could contribute to misalignment of the foot.

1. Equinus (plantarflexion)

2.Calcaneus (Dorsiflexion)

3. Varus (foot turns inward)

4. Valgus (foot turns outward)

DIAGNOSTIC TEST

1. RadiographyUse of x-rays is definitive diagnosis for clubfoot as it determines abnormal bone anatomy and assesses the treatment efficiency.

TREATMENT

Categories of treatment:A. For mild cases: manipulation, cast and splint application

(nonsurgical management)

B. For severe cases: surgery

NON-SURGICAL MANAGEMENT