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Clubfoot Presentation
Clubfoot Presentation
(Clubfoot)
Anatomy/Terminology
•3 main sections
1.Hindfoot – talus,
calcaneus
2.Midfoot – navicular,
cuboid, cuneiforms
3.Forefoot –
metatarsals and
phalanges
Anatomy/Terminology
• Important joints
1. tibiotalar (ankle) – plantar/dorsiflexion
2. talocalcaneal (subtalar) – inversion/eversion
• Important tendons
1. achilles (post calcaneus) – plantar flexion
2. post fibular (navicular/cuneiform) – inversion
3. ant fibular (med cuneiform/1st met) – dorsiflexion
4. peroneus brevis (5th met) - eversion
Anatomy/Terminology
• Varus/Valgus
Talipes Equinovarus (congenitalclubfoot)
Etiology
1. The Talus
- Medial & plantar deviation of the anterior end of
the talus
- “declination angle” : by the long axis of the head
& neck of the talus with the long axis of its body
- Obliquity the neck of talus : medial tilting of the
anterior part of the talus (adult : 12-32 degrees,
fetus : 35-75 degrees, CTEV : 50-65 degrees)
2. The Calcaneus
- Much less deformed than the talus
- Rotated on its long axis inward & downward
beneath the talus
- The sustentaculum tali usually
underdeveloped
& in close proximity to the medial maleolus
Clinical picture :
- Clublike appearance
- Deep creases at the posterior aspect of the
ankle joint
- Mid & forefoot are adducted, inverted & equinus
- The navicular bone abuts the anterior & medial
margin of the medial maleolus, on palpation
can’t insert a finger between the two bones
Radiographic Assessment
-The purpose is to define precisely the anatomic
relationship of talocalcaneonavicular, tibiotalar,
midtarsal & tarso-metatarso joint
-To assess the degree of subluxation of the
talocalcaneonavicular joint & the severity of the
deformity before treatment
- To provide an accurate guide to progress during the
course of closed non operative treatment
- To assess wether reduction of the talocalcaneonavicular
dislocation & normal articular alignment have been
achieved
Normal range of roentgenographic
angles
• Talocalcaneal angle
– Anteroposterior view: 30 to 55 degrees
– Dorsiflexion lateral view : 25 to 50 degrees
• Tibiocalcaneal angle
– Stress lateral view : 10 to 40 degrees
• Talo-first metatarsal angle
– Anteroposterior view : 5 to 15 degrees
Treatment
The objective :
1. To achieve reduction of the dislocation or
subluxation of the talocalcaneonavicular joint
2. To maintain the reduction
3. To restore normal articular alignment of the
tarsus & the ankle
4. To establish muscle balance between the evertors
& invertors, and the dorsiflexors & plantarflexors
5. To provide a mobile foot with normal function &
weight bearing
- Treatment should be started as soon as
possible, immediately following birth
- The first three weeks of life are the golden
period, because the ligamentous tissues
are still lacks under the influences of
maternal sex hormones
- Managements extends until adolescent
Closed Non-Operative Method
- A dynamic corrective
force is transmitted to the
foot
- In expensive, applied
easily, reapplied at
frequent intervals
- Relatively safe
- Being least likely to cause
pressure sores
Closed reduction of the medial & plantar
dislocation of talocalcaneonavicular joint