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Clubfoot

Clubfoot

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Published by: mikuteki on Aug 12, 2010
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04/24/2013

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Bicol University Tabaco Campus Department of Nursing Tabaco City

Submitted by: CEDI ANGELI ENCINAS MORESCA BUTC Summer Affiliation Group 5

Submitted to: Mrs. SHIELA B. CENETA, R.M., R.N. Clinical Instructor

4.  This can be caused by external influences in the final trimester such as intrauterine compression from oligohydramnios or from amniotic band syndrome. and pes. This was originally used to designate a foot deformity that causes the patient to walk on the ankle. meaning foot. cerebral palsy and tethered cord. Causes y Mainly idiopathic y Theories that is being associated with clubfoot:  Common to individuals with Edwards syndrome. 4 cardinal position of the foot: 1. This is a condition resulting from a genetic abnormality in which an extra chromosome is present. specifically chromosome number 18 that has three instead of the usual two. It is a condition in which the affected foot tends to be smaller than in normal with the heel pointing inward and downward and remains stuck in this position that resists realignment. 2. III. .  Breech presentation.  The mother of a clubfoot baby used methylenedioxymethamphetamine (MDMA) or commonly known as ecstasy while having her baby in her womb. Varus or inversion Valgus or eversion Equinos or plantar flexion Calcaneus or dorsiflexion  1 per 1000 live births  Common in males  Most common disorder of the legs and can range from mild and flexible to severe and rigid II.  May be associated with neurogenic conditions such as spina bifida cystica.CLUBFOOT Clubfoot is used in connection with many foot deformities whether congenital or acquired. 3. Alternative names: Talipes Talipes equinovarus Etiology: Talipes came from two Latin words talus which means ankle.

Never the head of the first metatarsal on the plantar surface of the foot are two sesamoid bones (a small. It also provides attachment for several tendons. oval shaped bone which develops inside a tendon. It supports our body weight and serves as a lever that allows us to propel our bodies forward when we walk and run. The forefoot includes the five metatarsal bones and the phalanges (the toes). The bones in the foot are arranged to form 3 strong arches: 2 longitudinal (medial and lateral) and one transverse. cuboid and 3 cuneiform). Anatomy and Physiology The foot composed of the tarsals. each toe has three phalanges except the great toe which has two. The talus and the calcaneous make up the midfoot. third. . Body weight is mostly carried by the two heel bones and the talus which lives between with tibia and the calcaneus. and 14 phalanges form the toes. The tarsus forming the posterior half of the foot is composed of seven tarsal bones. and fourth metatarsal bones are the most stable of the metatarsals. where the tendon passes over a bony prominence). Proximally the 3 cuneiforms articulate with the navicular bone. The talus rests on top of it and forms the pivot of the ankle. The midfoot meets the forefoot at the five tarsometatarsal (TMT) joints. Ligaments which bind the foot bones together and tendons of the foot muscles help to hold the bones firmly in the arched position but still allow a certain amount of give or springs. The mild foot includes 5 of the 7 tarsal bones (the navicular. 5 metatarsals form the sole. metatarsals and phalanges has two important functions. Weak arches are referred to as fallen arches or flat feet . The distal row contains the 3 cuneiforms and the cuboid.IV. The second. They are well protected and have only minor tendon attachments and are not subjected to strong pulling forces. The calcaneous is the largest tarsal bone and forms the heel. They are held in place by their tendons and are also supported by ligament. The first metatarsal bone bears the most weight and plays the most important role in propulsion. Like the fingers of the hand. There are multiple joints within the midfoot itself. It is the shortest and the thickest.

the foot is twisted in towards the other foot. Signs and Symptoms y y y y y y y High arched foot that may have a crease-cross of the sole of the foot The heel is drawn up The toes are pointed down The bottom of the foot (heel) is pointed away from the body. Pathophysiology Non-modifiable Factors: y y y Genetics Sex Maternal illness Modifiable Factors: y y Maternal lifestyle Breech presentation Arrest in fetal development of skeletal and soft tissue during 9-10 weeks T gestation Defective cartilage with ligaments laxity Shortening of medial cartilage CLUBFOOT VI.V. Laboratory and Diagnostic Procedure y y y CT Scan X-Ray Physical examinations . thus. The foot and leg may be smaller in comparison to a comparatively normal child The foot will lack motion and be noticeably stiff The calf muscle may also be smaller VII.

Denise Browne splint brace for clubfoot. . followed by realignment of the ends to allow healing. Hypothetical Diagnoses 1. Open reduction surgical procedure at enables the surgeon to reduce (repair) the fractures under direct visualization open reduction internal fixation (ORIF) is done that includes pins.VIII. Until usually 8-12 weeks but still depends on the severity of the case. for cases in which conservative treatment has failed. wires and rods inserted through bone fragments or fixed to the side of the bone. 4. especially if the child is allowed to walk on it. Medical and Surgical Management 1. 5. Teach parents postural drainage and exercises for child by the use of blowing bubble to increase lung expansion. by changing the biomechanics of the joint. Risk for disproportionate growth related to congenital disorders. Ensure proper fitting and wearing off the cast and splints. Make sure toes are visible at the end of the cast. IX. For respiratory problem: hypostatic pneumonia Raise head if mattress rather than head to prevent flexion of the neck. Serial casting began immediately or shortly after birth. VIII. Ponseti method daily or weekly manipulation and stitching of tissues of the affected extremity by the use of casts and simple exercises. plates. 3. 3. 2. Encourage parents to seek immediate medical care. Cast care Watch for signs of weakness and wear of the cast. nails. Ensure the cast is not too tight nor too loose. Nursing Management and Intervention y y y y y y Regular neurovascular checks on the affected toes Observe toes for signs of circulatory impairment. The operation is performed to reduce pain and disability in an arthritic joint. Serial manipulation repeated frequently every few weeks for 1-2 weels then at 1-2 weeks interval to accommodate rapid growth of early infancy. Impaired physical mobility related to musculoskeletal impairment. 2. Osteotomy a surgical operation to cut a bone into two parts. screws. 6. Skin care to prevent formation of hot spots and ulcerations Prevent infection Explain the importance of the procedure to the child s parents and relatives Teach the parents all necessary care of emphasize the need for follow-up which may be prolonged. Impaired skin integrity related to musculoskeletal impairment.

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