CONGENITAL ae TALIPES EQUINOVARUS (CLUBFOOT) ARONCE, ANGELINE JOY J. SN 3-4 OOVERVIEW Clubfoot refers to a variety of foot abnormalities that are typically observed at birth (congenital), resulting in the twisting or misalignment of the baby's foot. In this condition, the tendons, which connect the muscles to the bones, are shorter than normal. Clubfoot isa relatively common congenital defect and often occurs as an isolated issue in an otherwise healthy newborn. The severity of clubfoot can vary, and approximately half of the affected children experience it in both feet. Due to the potential impact on normal walking ability, medical professionals generally advise early treatment for clubfoot shortly after birth.Types Of Clubfoot Idiopathic Clubfoot A true (idiopathic) clubfoot accounts for the vast majority of cases. This type is stiff or rigid, and very hard to manipulate. Positional Clubfoot with a condition known as positional clubfoot. This flexible type of club foot is caused by the baby’s prenatal position in the uterus (often breech). Positional clubfoot can easily be positioned into a neutral (not curved) position by hand. Syndrome Clubfoot A third type is syndrome clubfoot—in which the condition is part of a larger syndrome. This type is usually more severe and difficult to treat, with less positive outcomes.Symptoms of Clubfoot * Plantar flexion: Twisting of the ankle. © Cavus foot deformity: An unusually high arch in the foot. * Varus: An inversion of the heel that causes the front of the foot to turn inward. * Adduction of the forefoot: the forefoot is pulled downward. Oyt ECAUSES: While the precise cause of clubfoot remains uncertain, medical experts concur that a family history of clubfoot raises the chances of a child being born with this condition. Additionally, maternal smoking and alcohol consumption during pregnancy have been associated with an increased risk of having a baby with clubfoot or clubfeet. It is worth noting that clubfoot can also be linked to congenital skeletal abnormalities like spina bifida.ANATOMY AND PHYSIOLOGY Tendons: Tendons are soft tissues that connect muscles to bones. In clubfoot, the tendons responsible for controlling foot movements are shorter than usual. This abnormal tendon length leads to the characteristic twisting and misalignment of the foot. Bones and Joints: Clubfoot affects the bones and joints of the foot. The bones may be misshapen or positioned incorrectly, particularly in the ankle and midfoot regions. The Joints, which facilitate movement, can be rigid and restricted in their range of motion due to abnormal positioning. The muscles of the foot play a vital role in ing proper foot alignment and movement. in clubfoot, the muscles may be imbalanced underdeveloped. Some muscles may be tight and overac while others may be weak or inactive. This muscle imbalance further contributes to the abnormal positioning of the foot.ANATOMY AND PHYSIOLOGY Ligaments and Connective Tissues: Ligaments are strong bands of connective tissue that stabilize joints. In clubfoot, the ligaments may be lax or overstretched, failing to provide adequate support for the affected foot. This lack of stability contributes to the deformity and hinders normal foot function. Blood Supply and Nerves: The blood vessels and nerves that supply the foot can be affected in clubfoot. Reduced blood flow to the affected area may impact tissue health and contribute to the development of deformities. Nerve compression or irritation may result in altered sensation or motor control in the foot.PATHOPHYSIOLOGYNON MODIFIABLE MODIFIABLE Environmental factors: -Severe deformity - Exposure to tobacco smoke while pregnant. -Ethnicity ; -Insufficient amniotic fluid -Level of education levels during pregnancy. attained by parents -Inadequate levels of the fluid surrounding the fetus in the uterus may raise the likelihood of developing clubfoot.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LABORATORY AND DIAGNOSTIC EXAM * Clubfoot is typically identified during a prenatal ultrasound examination, which utilizes high-frequency sound waves to generate images of the developing fetus in the uterus. * Clubfoot can potentially be detected through prenatal ultrasound as early as 13 weeks into the pregnancy. However, it is more commonly identified during a routine ultrasound conducted around 20 weeks of gestation.X-ray and CTscanMEDICAL MANAGEMENTManipulation and Casting: The Ponseti method begins with gentle eet ee ee er Seen eee eee ees Se eee eee aes ee ee ae ae ears seen eer ie eereeet ee a \Cee RL See eee Peer) Coes eee pe eenenenes ea progress of the treatment and make any necessary adjustments In some cases, if the deformity i severe or does not respond to non surgical methods, srgical intervention may be reer!SURGICAL MANAGEMENTFOR THE SURGICAL MANAGEMENT: ‘* In the past, surgery for clubfoot was considered when nonoperative treatments had plateaued, and the child had grown enough for clear anatomical assessment. There are no specific reasons to avoid surgery, but it is generally recommended around six months of age, considering the child's size and development. * Surgical correction of clubfoot used to follow a standardized approach without considering the severity of the condition. All patients underwent the same procedure. However, Bensahel introduced a personalized approach, where only the necessary structures are released during surgery. This tailored surgical technique is designed to address the specific deformity of each patient.Posteromedial Release * Asa last resort for clubfoot, a complete release surgery is performed. This involves releasing tight tendons and ligaments in the back and inner parts of the foot. These structures are then repositioned and stitched together ina lengthened position. The goal is to improve the foot's alignment and flexibility. Tendon Transplant * Surgery for clubfoot is typically performed between the ages of 4 and 7 years when other attempts to correct the condition have been unsuccessful. At this stage, the child's foot has fully developed, and surgery is considered as a final option to address the deformity.NURSING CARE PLAN