TALIPES

By : Madam Rohimah bt Ismail

ALPINE SKI HOUSE

LEARNING OUTCOME
1. State the definition of talipes
2. State the etiology of talipes
3. State the type factor for talipes
4. State the clinical manifestation of talipes
5. State the diagnostic for talipes
6. State the treatment of talipes

ALPINE SKI HOUSE 2

INTRODUCTION

Talipes is a deformity of the foot and ankle that a child can be born
with this problem.

The term “talipes” was coined by Little in 1839. He derived it from

the Latin “Talus”(ankles) and pes( foot)

ALPINE SKI HOUSE 3

DEFINITION

• Clubfoot is a complex deformity

of foot result of complicated
interrelationship between
bone, ligaments and muscles.

ALPINE SKI HOUSE 4

CONT ..

• It occurs in one out of 1000 live

birth.
• Boys affected twice more than
girls

ALPINE SKI HOUSE 5

ETIOLOGY

• Hereditary-defective gene
• Excessive pressure of amniotic fluid on
fetus causes excessive pressure of uterine
wall on fetus.
• Mechanical cause(Uterine compression)
• Arrested fetal development
• Circulatory failure to calf and foot muscles
• Irradiation(maternal) during pregnancy.

ALPINE SKI HOUSE 6

CLASIFICATION

1. Talipes Equinovarus:
• 95% all cases.
• The foot is fixed in plantar flexion
and deviates medially that is the
heal is elevated.
• The child walks on the toes and the
outer boarder of the foot.

ALPINE SKI HOUSE 7

CONT ..
Talipes Calcaneovalgus:

• In this the foot is dorsiflexed and

deviates laterally that is the heel is
turned outward from the midline of
the body and the anterior part of
the foot is elevated on the outer
border.

• If not corrected the child walks on

the outwardly turned heel and the
inner border of the foot.

• These conditions may be unilateral

or bilateral ALPINE SKI HOUSE 8
• 3. Talipes varus:
• The heel’s being turned inward from the
midline of the leg.
• Only the outer portion of the sole rests on
the floor

ALPINE SKI HOUSE 9

4.Talipes valgus:
• Due to the heels being turned
outward from the midline of the leg.
• Only the inner side of the sole rests
on the floor

ALPINE SKI HOUSE 10

5. Talipes Equinovalgus:
• Due to the heels being elevated and turned
outward from the midline of the body.
6. Talipes calcaneovarus:
• Due to the heels being turned towards the
midline of the body and anterior part of the
foot being elevated .
• Only the heels rests on the floor.

ALPINE SKI HOUSE 11

CLINICAL
MANIFESTATION

Usually, clubfoot is painless in children.

• Discomfort and become a noticeable disability.

• The foot will remain twisted out of shape and the

affected leg, may be shorter and smaller than the
other.

• Poor child growth and development.

• Body image disturbance

• The calf muscles are generally underdeveloped

• Stiff rigid, foot of varying degrees.

ALPINE SKI HOUSE 12
DIAGNOSTIC
EVALUATION
• History collection

• Physical examination

• Ultrasound scanning during pregnancy

• X-rays

ALPINE SKI HOUSE 13

MANAGEMENT

Non operative management:

• Two categories of clubfoot are identified.
• 1. Easy or correctable clubfoot: which is
corrected with manipulation , casting and
splintage alone.
• 2. Resistant clubfoot: It is that which
responds poorly to splintage and
manipulative treatment. It requires
operative management

ALPINE SKI HOUSE 14

• Ponseti method is popular manipulation
method to correct clubfoot.

• This is not painful or uncomfortable for the

child.

• The surgeon will do gentle movements and

stretches with the baby's foot before each
cast is put on. These help slowly move the
foot toward its correct position. Then, the
cast is put on to hold that new position until
it's time for the next cast

ALPINE SKI HOUSE 15

Surgical management

• In children younger than 5 years , correction

can be achieved with soft tissue procedure.

• Children older than 5years require bone

reshaping eg. Dorselateral wedge excision of
the calcaneocuboid joint or osteotomy of
the calcaneum to correct varus.

• Lateral wedge torsectomy or triple fusion is

required if the child is older than 10 years.

ALPINE SKI HOUSE 16

NURSING DIAGNOSIS

• Impaired skin integrity related to application of casts

• Parental anxiety related to club foot

• High risk for body image disturbance related to

deformity of club foot

ALPINE SKI HOUSE 17

ALPINE SKI HOUSE 18
ALPINE SKI HOUSE 19
MUSCULAR
DISTROPHY

ALPINE SKI HOUSE

LEARNING
OUTCOME
• State the definition of MD

• State the causes of MD

• State the risk factor for MD

• State the symptom of MD

• State the complication of MD

• State the diagnostic for MD

• State the treatment of MD

ALPINE SKI HOUSE 21

DEFINITION
Muscular dystrophy (MD) is a genetic disorder
that gradually weakens the body's muscles.

It's caused by incorrect or missing genetic

information that prevents the body from
making the proteins needed to build and
maintain healthy muscles.

A child who is diagnosed with MD gradually

loses the ability to do things like walk, sit
upright, breathe easily, and move the arms and
hands.

ALPINE SKI HOUSE 22

TYPE OF MD

Major types:

• Duchenne and Becker,

• Emery-Dreifuss

• Limb-girdle,

• Oculopharyngeal,

• Facioscapulohumeral,

ALPINE SKI HOUSE 23

CONT ..

• Can occur at any age

• Most common in young males.
• Type is based on what age the individual is when muscular dystrophy appears
• Also depends on how severe the disease is, which muscles it affects, rate of
progression.
• Some types of muscular dystrophy only affect males.
• Some individuals with this disease experience mild symptoms, while others suffer
from severe muscle weakness, dying at an early age.

ALPINE SKI HOUSE 24

CAUSES
Certain genes are involved in making proteins
that protect muscle fibers. Muscular dystrophy
occurs when one of these genes is defective.

Each form of muscular dystrophy is caused by a

genetic mutation particular to that type of the
disease. Most of these mutations are inherited.

ALPINE SKI HOUSE 25

RISK FACTOR

• Muscular dystrophy occurs in both

sexes and in all ages and races.
• However, the most common variety,
Duchenne, usually occurs in young
boys.
• People with a family history of
muscular dystrophy are at higher risk
of developing the disease or passing
it on to their children.

ALPINE SKI HOUSE 26

SYMPTOM
Muscle weakness.

Myotonic: muscle spasms or stiffening

after use, hand weakness, foot drop

Clumsiness, frequent falling, difficulty

getting up, waddling gait, curvature of
the spine.

Drooling, eyelid drooping

ALPINE SKI HOUSE 27

COMPLICATION

• Trouble walking. The child with muscular dystrophy eventually need to use a wheelchair.

• Trouble using arms. Daily activities can become more difficult if the muscles of the arms and shoulders are affected.

• Shortening of muscles or tendons around joints (contractures). Contractures can further limit mobility.

• Breathing problems. Progressive weakness can affect the muscles associated with breathing. The child with MD might
eventually need to use a breathing assistance device (ventilator), initially at night but possibly also during the day.

• Curved spine (scoliosis). Weakened muscles might be unable to hold the spine straight.

• Heart problems. Muscular dystrophy can reduce the efficiency of the heart muscle.

• Swallowing problems. If the muscles involved with swallowing are affected, nutritional problems and aspiration pneumonia
can develop. Feeding tubes might be an option.

ALPINE SKI HOUSE 28

 Muscle biopsy

DIAGNOSTIC
DNA testing

Blood enzyme tests

Electromyography or nerve conduction

tests

Electrodes are used to test the muscle

and/or nerves

ALPINE SKI HOUSE 29

TREATMENT

• No cure

• Medications and therapy can relieve symptoms and

slow progression of the disease

• However, scientists are researching ways to insert a

working dystrophin gene into muscles of boys with
Duchenne and Becker MD

• Also, researchers are exploring potential muscle-

building drugs to help reverse progression

• Dietary supplements, creatine, and glutamine are other

potential treatments being studied

ALPINE SKI HOUSE 30

CONT…

• Braces, wheelchairs, and canes can improve mobility

• Surgery on the spine or legs also may be an option to

improve function.

• Exercise! People suffering from MD should be as active

as possible. Primary focus is on gaining muscular
strength and endurance

• Physical inactivity may make the disease worse

ALPINE SKI HOUSE 31

MEDICATION
Corticosteroids can slow muscle damage in
patients with Duchenne muscular dystrophy.

Phenytoin, procainamide, or quinine may treat

delayed muscle relaxation for those with
Myotonic MD.

Medications can also be prescribed to treat

heart problems in some forms of muscular
dystrophy

ALPINE SKI HOUSE 32

ALPINE SKI HOUSE 33