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Congenital Talipes Equinovarus (Club
Foot)Donald A. Manuain
11-2012-175
Clubfoot is the most important congenital abnormality of the foot.
It is easy to diagnose but difficult to correct. Consist of a combination of deformities:
◦ Forefoot adduction and supination through midtarsal joint.
◦ Heel varus through the subtalar joint.◦ Equinus through the ankle joint.◦ Medial deviation of whole foot in relation to the
knee.
Overview
1-2 in 1.000 live births. Bilateral in one third of the afflicted
children. Affect boys twice as often as girls. Genetic factor in 10% of the children. IF one parent and one child have clubfoot
1 in 4 chances the subsequent child being afflected.
Incidence
Etiology remains questionable, but the possible cause is neuromuscular defect.◦ The muscle on the posterior and medial aspect of
the leg (calf muscle and the tibialis posterior) are short.
◦ The fibrous capsules of all the deformed joints are thick and contracted.
◦ This contractures become resistant to correction as the time goes by.
Etiology and Pathology
Mild clubfoot must be distinguished from positional equinovarus.
Teratologic type of severe clubfoot deformity usually associated with spina bifida.
Diagnosis
General treatment include:◦ Gentle passive correction of the deformities.◦ Maintenance of correction for a long period of
time.◦ Supervision of the child until the end of growth.
Possible recurrence of deformity should be watched for and treated.
Treatment
Outflare boots are used for day wear until the child is 3 years of age.
Dennis Brown type boot splint or articulated AFO to be worn day and night (3 months).
Dennis Brown type of clubfoot splint by adhesive tape (8 weeks)
Plaster cast applied weekly (6 weeks)
General Plan of Treatment
Approx. 40 % of congenital clubfeet treated early by these method will responds in 3-4 months of treatment.
Remaining 60% are resistant to these methods.◦ Continuation leads to failure, because of persistent
incomplete correction or recurrence of deformity.◦ Immobilization pressure necrosis in joint cartilage.
Operative treatment is a meticulous soft tissue correction of all tendon and joint contractures at 4 to 6 months.
Treatment
Principal: Complete release of the joint (capsular and
ligamentous contractures and fibrotic bands).
Lengthening of the tendons so the foot can be positioned normally.
Opeative Treatment
Post op, non operative plan is resumed to maintain the correction.
Neglected clubfeet and recurrent clubfeet always require operative treatment.
Soft tissue operation are effective in the first 5 years of life and become less effective in older children.◦ In older children, bone operation (arthrodesis of
the subtalar and midtarsal joint) use to correct any residual deform. until 10 years of age.
Treatment
40 % patients have satisfactory result from early non operative treatment.
Complete surgical correction for resistant clubfeet at 3-4 months of age make a better prognosis.
Early diagnosis and management play a big role in treating clubfeet.
Prognosis
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