Club Foot

Moderated By:- Dr Rashmi Malhotra

Presented By:- Kanishk Datta
Roll No:- 41
MBBS:- 2019 batch
AIIMS RISHIKESH
Learning objectives
• Anatomy
• Nomenclature
• Cause
• Deformities
• Diagnosis and treatment
Club Foot meaning
• Vague term referring to foot deformities
• Most commonest being Congenital Talipes Equino Varus (CTEV)
Relevant anatomy
• Foot divided into 3parts :
1. hindfoot: talocalcaneal joint and calcaneocuboid joint
2. Midfoot: talonavicular and naviculo-cuneiform joint
3. forefoot: cuneiform-metatarsal joint
Ligaments and tendons of foot
• Ligaments
1.Deltoid ligament: MCL of ankle
2. Spring ligament
3.Interosseus ligament
4.Capsular ligament
5.Planter ligament: for longitudinal arch
• Tendons: tendons on the medial side posterior to medial malleolus
1.Tibialis posterior (muscle is also involved)
2.F. digitorum longus
3.F. hallucis longus
Nomenclature
Equinus: foot is fixed in plantar-flexion
Calcaneus (reverse of equinus): foot is fixed in dorsiflexion
Varus: foot is inverted and adducted at the mid-tarsal joints so that the
sole ‘faces’ inwards
Valgus: foot is everted and abducted at the mid-tarsal joints so that the
sole ‘faces’ outwards
Cavus: longitudinal arch is exaggerated
Planus: longitudinal arch is flattened
Splay: transverse arch is flattened
Causes
• idiopathic clubfoot: causes unknown (majority of the cases)
• Secondary clubfoot: paralytic shock and disorder of development of
muscles (Arthrogryposis multiplex congenita)
Deformities
• Bones: smaller than normal
• Muscles: calf muscles underdeveloped
• Ligaments: ligaments on medial side of foot are shortened
• Joints:
1. equinus: occurs at ankle joint
2. Inversion: inverted calcaneum so whole foot faces medially
Diagnosis
• General examination
Check if foot is in equinus, Varus or adduction condition. Foot should
move to opposite direction in normal condition.
Check for deformities and bony prominences
• X-ray: useful in late presenting cases
Kite’s Angle: angle between long axis of talus and calcaneum
Normal kite’s angle is 35 degree.
Kite angle <35 degree in talipes equino varus
Clinical vignette 1
A 1.5yr old child was delivered in the hospital with full term normal
delivery. At about 1yr age it was observed that she had difficulty
standing up and was bearing more weight on the medial aspect of her
foot. On general examination it was found that her foot was fixed in
planter flexion position and was everted and abducted. Based on your
knowledge of anatomy what is the probable deformity she is suffering
from?
Clinical vignette 2
A 5yr old boy is brought to the orthopaedic ward after his parents
notice that he had difficulty in walking. On general examination is was
noticed that there was there was difficulty in dorsiflexing the foot. An
Xray was ordered. What is the most probable deformity based on the x-
ray.
MCQ
Which of the following is wrongly matched?
1. Equinus: fixed plantar-flexion
2. Calcaneus: fixed dorsiflexion
3. Varus: inverted and adducted
4. Valgus: inverted and adducted
MCQ
Which of the following is not involved in Club foot?
1. Tibialis anterior
2. Ankle joint
3. Deltoid ligament (MCL of ankle)
4. Spring ligament
MCQ
Acknowledgement
I am grateful to Dr. Rashmi Malhotra and Ms. Bharti for being my
mentor and guide in preparing this presentation.
Thank you
References
• Essential orthopaedics, fifth edition, J Maheshwari ( MS-orth AIIMS),
pg 210 – pg218