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Published by Lorebell

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Published by: Lorebell on Jul 24, 2009
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ClubfootI. Definition
Clubfoot is a condition in which one or both feet are twisted into an abnormalposition at birth. The condition is also known as talipes.It is a general term used to describe a range of unusual positions of the foot. This ispresent at birth and affects the foot and/or ankle. There is no known cause for clubfoot,and it is twice as common in male children as it is in female children. Most type of clubfoot is present at birth which can happen in one foot or in both feet. In almost half of affected infants, both feet are involved.Although clubfoot is painless in a baby, treatmentshould begin immediately. Clubfoot can cause significantly problems as the child grows,but with early treatment most children born with clubfoot are able to lead a normal life
Giles Smith syndrome,
Talipes equinovarus; Talipes
III. Incidences
The frequency of congenital clubfoot is approximately 1 per 1,240 live births. Inchildren there is a subtle imbalance in muscle forces in the lower leg resulting in the footdeformity. Often, the foot is ‘kidney- shaped”. About 50% of the time, both feet areaffected with clubfoot. In USA, there are 1-2 cases for every 1000 live births. The ratioof males to females with clubfoot is 2.5 to 1.
IV. Risk/ Predisposing Factors
Risk factors may include:
Family history of clubfoot.
Position of the baby in the uterus.
Increased occurrences in those children with neuromuscular disorders, such ascerebral palsy (CP) and spina bifida.
Oligohydramnios (decreased amount of amniotic fluid surrounding the fetus inthe uterus) during pregnancy.
V. Manifestation
Although there is no known cause of congenital clubfoot, some doctors believe theuse of drugs or alcohol during pregnancy or the presence of other diseases can causeit. In some cases, clubfoot is just the result of the position of the baby while it isdeveloping in the mother’s womb.Clubfoot is painless in a baby, but it can eventually cause discomfort and become anoticeable disability. Left untreated, clubfoot does not straighten itself out. The foot willremain twisted out of shaped, and the affected leg may be shorter and smaller than theother. These symptoms become more obvious and more of a problem as the childgrows.
Fixed plantar Flexion (equinos) of the ankle, characterized by the drawn up positionof the heel and inability to bring the foot to a plantigrade (flat) standing position. Thisis 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.
Abnormal (slightly smaller) size of foot & calf muscles.
The heel cord (Achilles tendon) is tight causing the heel to be drawn up toward theleg.
VI. Type/ Stage/ Classification
There are two categories of clubfoot/ talipes equinovarus(TEV).
Structural TEV is caused by:geneticfactors, such asEdwards syndrome, a genetic defect with three copies of chromosome 18. Growth arrests at roughly 9 weeks andcompartment syndrome of the affect limb are also causes of Structural TEV. Geneticinfluences increase dramatically with family history.
Postural TEV could be caused by external influences in the final trimester such asintrauterine compressionfrom oligohydramniosor fromamniotic band syndrome. However, this is countered by findings that TEV does not occur more frequently thanusual when the intrauterine space is restricted.
VII. Pathophysiology

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