Disease Overview

talipes equinovarus (Clubfoot)- is a birth defect that affects the foot and ankle. It’s a congenital
condition, which means that a baby is born with it. The foot or feet turn inward. When you look
at the foot, the bottom of the foot often faces sideways or even up.

Clubfoot happens because of a problem with the tendons, the tissues that connect muscle to
bone. The tendons in the baby’s leg and foot are shorter and tighter than they should be. That
causes the foot to twist.

Extensive surgery used to be the main treatment to correct clubfoot. But today healthcare
providers typically use a combination of nonsurgical methods and a minor procedure.

There are two types of clubfoot:

 Isolated or idiopathic clubfoot is the most common type. If your child has clubfoot with no
other medical problems, it’s called isolated clubfoot. Idiopathic means that the cause of
clubfoot is not known.
 Non-isolated clubfoot happens along with other health problems. These conditions
include arthrogryposis (a joint problem) and spina bifida (a neural tube disorder). Neural
tube defects are problems of the brain, spine and spinal cord.

 Signs and symptoms.

 The top of the foot is usually twisted downward and inward, increasing the arch
and turning the heel inward.

 The foot may be turned so severely that it actually looks as if it's upside down.

 The affected leg or foot may be slightly shorter.

 The calf muscles in the affected leg are usually underdeveloped

Anatomy and psysiology mus

.

 Skeletal muscle: This type of muscle creates movement in the body. There are more
than 600 skeletal muscles, and they make up about 40 percent of a person’s body
weight. When the nervous system signals the muscle to contract, groups of muscles
 work together to move the skeleton. These signals and movements are nearly
involuntary, yet they do require conscious effort. However, humans do not need to
concentrate on individual muscles when moving.

 Cardiac muscle: Cardiac muscle is involuntary muscle. This type makes up the walls of
the heart and creates the steady, rhythmic pulsing that pumps blood through the body
from signals from the brain. This muscle type also creates the electrical impulses that
produce the heart’s contractions, but hormones and stimuli from the nervous system can
also affect these impulses, such as when your heart rate increases when you’re scared.

 Smooth muscle: Smooth muscle makes up the walls of hollow organs, respiratory
passageways, and blood vessels. Its wavelike movements propel things through the
bodily system, such as food through your stomach or urine through your bladder. Like
cardiac muscle, smooth muscle is involuntary and also contracts in response to stimuli
and nerve impulses

Psysiology

Skeletal muscle: -The skeletal system is the body system composed of bones, cartilages,
ligaments and other tissues that perform essential functions for the human body. Bone
tissue, or osseous tissue, is a hard, dense connective tissue that forms most of the
adult skeleton, the internal support structure of the body.

Cardiac muscle-  Cardiac muscle is controlled by the autonomous nervous system.

Cells in your brain and cells embedded throughout your heart act to release well-
timed nervous impulses which signal your heart cells to contract in the correct
pattern. While the source of the signals is different, the reception of the signal
and the rest of contraction are very similar.

Smooth muscle: n smooth muscle, the contraction is not controlled voluntarily by

the somatic nervous system, but by signals from the autonomous nervous
system, such as nerve impulses, hormones, and other chemicals released by
specialized organs. Smooth muscle is specialized to contract persistently, unlike
skeletal muscle which much contract and release quickly.

.
Organ involved (muscles, tendons, and bones)
Adduction and supination of forefoot
Inversion of heel
Fixed plantar plexion

 Pathophysiology

Risk factors

Boys are about twice as likely to develop clubfoot than girls are.

Cause and Risk factors

Causes
The true etiology of congenital clubfoot is unknown.
  Extrinsic factors. Extrinsic associations include teratogenic agents
(e.g., sodium aminopterin), oligohydramnios, and congenital
constriction rings.
 Genetic factors. Genetic associations include Mendelian inheritance
(eg, diastrophic dwarfism; autosomal recessive pattern of clubfoot
inheritance).
 Cytogenic factors. Cytogenetic abnormalities (e.g., congenital
talipes equinovarus [CTEV]) can be seen in syndromes involving
chromosomal deletion; it has been proposed that idiopathic CTEV in
otherwise healthy infants is the result of a multifactorial system of
inheritance.

 Congenital conditions. In some cases, clubfoot can be associated with other

abnormalities of the skeleton that are present at birth (congenital), such as spina
bifida, a birth defect that occurs when the spine and spinal cord don't develop or
close properly.

 Environment. Smoking during pregnancy can significantly increase the baby's risk

of clubfoot.

 Not enough amniotic fluid during pregnancy. Too little of the fluid that surrounds
the baby in the womb may increase the risk of clubfoot.

Diagnosis

Club foot is usually diagnosed after a baby is born, although it may be

spotted in pregnancy during the routine ultrasound scan carried out
between 18 and 21 weeks.

Club foot can’t be treated before birth, but picking up the problem during
pregnancy means you can talk to doctors and find out what to expect
after your baby is born.

Some babies are born with normal feet that are in an abnormal position
because they have been squashed in the womb.

The feet usually correct themselves by 3 months, but some babies may
need a few sessions of physiotherapy.
 Treatment

 Stretching and casting (Ponseti method)

 Surgery

 Brace

Nursing Care Plan 2 Actual and 2 Risk

Assessment Nursing diagnosis

History. Seek a detailed family  Risk for peripheral
history of clubfoot or neurovascular
neuromuscular disorders, and dysfunction relate
perform a general examination d to mechanical
to identify any other
compression
abnormalities.
Physical exam. Examine the (cast or
feet with the child prone, with
the plantar aspect of the feet brace).
visualized, and supine to
evaluate internal rotation and
varus; if the child can stand,
determine whether the foot is
plantigrade, whether the heel is
bearing weight, and whether it
is in varus, valgus, or neutral

Assessment Nursing Planning

diagnosis
 History. Seek a  Risk for Short term
detailed family impaired
history of clubfoot or parenting
neuromuscular related to After 8
disorders, and
maladaptive
perform a general
coping hours of
examination to
identify any other strategies nursing
abnormalities. secondary to
 Physical diagnosis of intervention
talipes
exam. Examine the
feet with the child deformity. As the Parents
prone, with the
plantar aspect of the
evidenced by explain
physical exam
feet visualized, disease
and supine to
evaluate internal state,
rotation and varus; if
the child can stand, recognizes
determine whether
the foot is the need for
plantigrade, whether
the heel is bearing medications
weight, and whether
 it is in varus, valgus,
or neutra
and
understand
s
treatments

Disease Overview

Duchenne muscular dystrophy and Becker muscular dystrophy - are X-

linked recessive disorders characterized by progressive proximal muscle
weakness caused by muscle fiber degeneration. Becker dystrophy has
later onset and causes milder symptoms. Diagnosis is suggested clinically
and is confirmed by genetic testing or analysis of the protein product
(dystrophin) of the mutated gene. Treatment focuses on maintaining
function through physical therapy and the use of braces and orthotics.
Patients who have Duchenne dystrophy should be offered prednisone or
deflazacort and sometimes exon-skipping treatments using antisense
oligonucleotides.
Signs and symptoms.

Fatigue

Mental retardation(possible, but does not worsen overtime)

Muscle weakness

Begins in the leg and pelvis but also occurs less severely in the arms neck
and other areas of the body

Difficulty with motor skill

Frequent falls
Progressive difficult walking(ability to walk may be lost by age 12)
Anatomy and Physiology of the System (muscular system)

 Skeletal muscle: This type of muscle creates movement in the body. There are more
than 600 skeletal muscles, and they make up about 40 percent of a person’s body
weight. When the nervous system signals the muscle to contract, groups of muscles
work together to move the skeleton. These signals and movements are nearly
involuntary, yet they do require conscious effort. However, humans do not need to
concentrate on individual muscles when moving.

 Cardiac muscle: Cardiac muscle is involuntary muscle. This type makes up the walls of
the heart and creates the steady, rhythmic pulsing that pumps blood through the body
from signals from the brain. This muscle type also creates the electrical impulses that
produce the heart’s contractions, but hormones and stimuli from the nervous system can
also affect these impulses, such as when your heart rate increases when you’re scared.

 Smooth muscle: Smooth muscle makes up the walls of hollow organs, respiratory
passageways, and blood vessels. Its wavelike movements propel things through the
bodily system, such as food through your stomach or urine through your bladder. Like
cardiac muscle, smooth muscle is involuntary and also contracts in response to stimuli
and nerve impulses

Psysiology

Skeletal muscle: -The skeletal system is the body system composed of bones, cartilages,
ligaments and other tissues that perform essential functions for the human body. Bone
tissue, or osseous tissue, is a hard, dense connective tissue that forms most of the
adult skeleton, the internal support structure of the body.

Cardiac muscle-  Cardiac muscle is controlled by the autonomous nervous system.

Cells in your brain and cells embedded throughout your heart act to release well-
timed nervous impulses which signal your heart cells to contract in the correct
pattern. While the source of the signals is different, the reception of the signal
and the rest of contraction are very similar.
Smooth muscle: n smooth muscle, the contraction is not controlled voluntarily by
the somatic nervous system, but by signals from the autonomous nervous
system, such as nerve impulses, hormones, and other chemicals released by
specialized organs. Smooth muscle is specialized to contract persistently, unlike
skeletal muscle which much contract and release quickly.

Organ Involved

 Pathophysiology
Cause and risk factor

Common causes

To understand the cause of muscular dystrophy, you need to understand how the disease affects
your muscles. Muscular dystrophy is characterized by progressive weakness and wasting of
muscle cells.2

Muscles are made up of bundles of fiber. Within each muscle fiber are clusters of myofibrils—the
building blocks of muscle that allow them to contract. In addition to myofibrils, muscle fibers contain
different types of proteins that work together to strengthen and protect the muscles from injury during the
process of contraction and relaxation.

Abnormalities in these proteins caused by genetic defects lead to the muscle weakness and
wasting that characterizes muscular dystrophy

Risk factor

Since there is a genetic factor for acquiring muscular dystrophy, there is no lifestyle change that
you can make to decrease your likelihood of getting it. If the genetic makeup is there and active
in specific chromosomes in your body, you may get muscular dystrophy.
However, researchers have identified risk factors for complications and early death for those who
already have muscular dystrophy. In a 2017 study published in the Journal of the American
Heart Association, researchers identified three common risk factors that were present in people
with Duchenne muscular dystrophy associated with cariomyopathy who experienced poor
outcomes including early death.5 These included:

 Being underweight
 Having poor lung function
 Having a high blood concentration of a protein linked to cardiac damage

Diagnosis

 Enzyme tests. Damaged muscles release enzymes, such as creatine

kinase (CK), into your blood. In a person who hasn't had a traumatic injury,
high blood levels of CK suggest a muscle disease.

 Genetic testing. Blood samples can be examined for mutations in some of

the genes that cause types of muscular dystrophy.

 Muscle biopsy. A small piece of muscle can be removed through an

incision or with a hollow needle. Analysis of the tissue sample can
distinguish muscular dystrophies from other muscle diseases.

 Heart-monitoring tests (electrocardiography and

echocardiogram). These tests are used to check heart function, especially
in people diagnosed with myotonic muscular dystrophy.

 Lung-monitoring tests. These tests are used to check lung function.

 Electromyography. An electrode needle is inserted into the muscle to be

tested. Electrical activity is measured as you relax and as you gently tighten
the muscle. Changes in the pattern of electrical activity can confirm a
muscle disease

Treatment

Although there's no cure for any form of muscular dystrophy, treatment for some forms
of the disease can help extend the time a person with the disease can remain mobile
and help with heart and lung muscle strength. Trials of new therapies are ongoing.

People with muscular dystrophy should be monitored throughout their lives. Their care
team should include a neurologist with expertise in neuromuscular diseases, a physical
medicine and rehabilitation specialist, and physical and occupational therapists
Treatment options include medications, physical and occupational therapy, and surgical and
other procedures. Ongoing assessments of walking, swallowing, breathing and hand function
enable the treatment team to adjust treatments as the disease progresses