INTRODUCTION

• Congenital – inborn; refers to a condition or trait that exists at birth.

• Talipes equinovarus:
• The common ("classic") form of clubfoot.
• Talipes is made up of the Latin talus (ankle) + pes (foot).
• Equino- indicates the heel is elevated (like a horse's) and -varus indicates it is turned
inward.
• Congenital Talipes Equinovarus (CTEV), often known as ‘club-foot’, is a common but
little studied developmental disorder of the lower limb.
• It is defined as fixation of the foot in adduction, in supination and in varus, i.e. inclined
inwards, axially rotated outwards and pointing downwards.
• The calcaneus, navicular and cuboid bones are medially rotated in relation to talus, and
are held in adduction and inversion by ligaments and tendons. Although the foot is
supinated, the front of the foot is pronated in relation to back of the foot, causing cavus.
• In addition, the first metatarsal is more plantar flexed. Congenital talipes equinovarus
is termed ‘syndromic’ when it occurs in association with other features as part of a
genetic syndrome, or it can occur in isolation in which case it may be termed
‘idiopathic’.

ANATOMY OF NEWBORN FOOT

TYPES

1. Talipes varus
• the most common form of clubfoot, the foot generally turns inward so that the leg
and foot look somewhat like the letter J.
2. Talipes valgus
• the foot rotates outward like the letter L.
3. Talipes equinus
• the foot points downward, similar to that of a toe dancer.
4. Talipes calcaneus
• the foot points upward, with the heel pointing down.
ETIOLOGY

Idiopathic Clubfoot
• Most common
Postural Clubfoot
• Caused by intrauterine molding (“cramped quarters”)
Neurogenic Clubfoot
• Spina bifida, tethered spinal cord, arthrogryposis
Syndromic Clubfoot
• Diastrophic dwarfism, Freeman‐Sheldon syndrome, Smith‐Lemli‐Opitz syndrom
RISK FACTORS

• Family history
o If either of the parents or their other children have had clubfoot, the baby is
more likely to have it as well.
• Congenital conditions.
o 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
o Smoking during pregnancy can significantly increase the baby's risk of clubfoot.
• Not enough amniotic fluid during pregnancy.
o Too little of the fluid that surrounds the baby in the womb may increase the risk
of clubfoot.

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS

• Inward Turning of The Front of The Foot

• Downward-Pointing Toes
• Resting Of the Foot on Its Outer Border
• Abnormal Shape of The Foot
• Rigidity And Other Changes in The Movements of The Foot
ASSSMENT AND DIAGNOSTIC PROCEDURES

MANAGEMENT AND TREATMENT

• Surgery used to be the main treatment for clubfoot, but orthopedic surgeons (doctors
who focus on conditions of the bones, muscles, and joints) now prefer the
PONSENTI METHOD.
• This is done in two phases:
o The CASTING phase, which gradually moves the foot to the correct
position
o The BRACING phase, which makes sure it stays there
• Casting usually starts when a baby is a week or two old. The baby will wear a series
of 5 to 7 casts over a few weeks or months. When the foot is in its final, correct
position, the baby is fitted with a brace.
• Supplemental surgical procedures such as tendoachilles lengthening and tibialis
anterior transfer may be required during the course of treatment to correct residual
deformity.
• Tendoachilles Lengthening
o When the tendon is stretched, the Z-shaped incision stretches and grows
longer. The surgeon then uses sutures (stitches) to sew the tendon in place.
This surgical method is the most controlled way to lengthen the whole
tendon and muscle.
• Tibialis Anterior Transfer
o a variation of the complete tibialis anterior tendon transfer where the tibialis
anterior tendon is split and the lateral half is secured into the lateral
cuneiform or cuboid.
• When initially introduced, the STATT procedure was used to treat children with
cerebral palsy and spastic equinovarus deformity.
PRIMARY NURSING DIAGNOSIS

o Disturbed body image related to permanent alteration in structure and/or function.

o Deficient knowledge related to the condition, prognosis, treatment, self-care, and
discharge needs.
o Risk for peripheral neurovascular dysfunction related to mechanical compression (cast
or brace).
o Risk for impaired skin integrity related to cast application, traction or surgery.
o Risk for impaired parenting related to maladaptive coping strategies secondary to
diagnosis of talipes deformity.

NURSING INTERVENTIONS

Protect skin integrity.

o Monitor site of impaired tissue integrity at least once daily for color changes, redness,
swelling, warmth, pain, or other signs of infection; monitor patient’s skin care practices,
noting type of soap or other cleansing agents used, temperature of water, and frequency
of skin cleansing; and provide gloves or clip the nails if necessary to avoid damaging
the skin with scratches.
Promote acceptance of body image.
o Acknowledge and accept an expression of feelings of frustration, dependency, anger,
grief, and hostility; support verbalization of positive or negative feelings about the
actual or perceived loss; and be realistic and positive during treatments, in health
teaching, and in setting goals within limitations.
Provide health education.
o Include the parents in creating the teaching plan, beginning with establishing objectives
and goals for learning at the beginning of the session; provide clear, thorough, and
understandable explanations and demonstrations; and render positive, constructive
reinforcement of learning.