Club Feet

Jananthan, Sandareka &

Sharmila

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

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 What is clubfoot?...
 It can affect one or both feet.
 It occurs in about one in every 1,000 live
births and affects boys twice as often as
girls.
 Fifty percent of clubfoot cases affect both
feet.

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 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 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…
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…
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…
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…
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. 9
 Diagnosis
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…
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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 Treatment
Treatment for any kind of clubfoot is started
as soon as possible after birth. The goal of
treatment is to obtain a lasting correction
and a foot that is functional and
cosmetically acceptable.
Treatment goals also should include making
the maximum attempt to maintain
normalcy in the lives of the patient and the
patient's family.

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 Treatment Types
 Manipulation
 Exercise
 Surgery
To maintain the correction, following
method can be use
Plaster Cast
Orthosis / Splint
Bandaging

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

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

95 years old and still going strong!

Dr. Ponseti applying a cast.
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 Serial Casting…(Ponseti
Casting…(
Method)
Does the Ponseti method always work?

Unfortunately, no. In some cases, surgery is

needed to correct the position of the clubfoot.
Most often this is needed in cases where the
child has other developmental problems (such
as arthrogryposis) or if the child begins
treatment more than a few months after birth.

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 Surgery
There are two minimal surgeries that may
be required:
1. Tenotomy (needed in 80% of cases) is a
release (clipping) of the Achilles tendon -
minor surgery- local anesthesia.
2. Anterior Tibial Tendon Transfer (needed
in 20% of cases) - where the tendon is
moved from the first ray (toe) to the third
ray in order to release the inward traction
on the foot.
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 Surgery…
Extensive Surgery & Complications:
May lead to scar tissue developing inside
the child's foot.
May result in functional, growth and
aesthetic problems in the foot.
May require on average 2 additional
surgeries to correct the issues mentioned.

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 Orthotic Management
 To maintain the Corrected position of the
Manipulation.

 To maintain the correction done by

surgery.

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 Orthotic Options
Dennis Brown splint
The splint is set at 60 to 70º of external
rotation, and 50º Dorsiflexion.

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 Orthotic Options…
Ankle Foot Orthosis
It can be used if the deformity is already
reduced, and the child needs to walk.

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 Orthotic Options…
Knee Ankle foot Orthosis set in
90deg knee Flexion
Maintain the foot abducted
and externally rotated. 90º
knee flexion position to
reduce the tension of
gastrocnemius, which make
easy to correct the equinus.

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 Complications
 Fix deformity of Talipes Equino Varus.

 Patient walk with lateral border of foot

touching the ground

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

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That’s it! Thanks
for your
attention…
Are there any questions?

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 References
http://www.kuspito.co.cc/2009/02/orthotic-management-of-club-foot.

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

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

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

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

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

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