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ROSS ANNE CAROLINO

CLUBFOOT ---->
yIt is the abnormal rotation of foot at

ankle. yA common malformation of the foot that is evident at birth

Other Name:
Talipes  most common type of club foot is Talipes Equinovarus

Types of clubfoot yVarus (inward rotation): would walk on ankles, bottoms of feet face each other yValgus (outward rotation): would walk on inner ankles yCalcaneous (upward rotation): would walk on heels yEquinas (downward rotation): would walk on toes

Risk factors
yGender yFamily history of clubfoot

Causes: y Unknown (idiopathic) y Position of the baby in the uterus y Increased occurrences in those children with neuromuscular disorders, such as cerebral palsy (CP) and spina bifida. y Oligohydramnios (decreased amount of amniotic fluid surrounding the fetus in the uterus) during pregnancy.

INCIDENCE y1 in 1000 livebirths yMost common deformity (95%) is talipes equinovarus yOccurs more frequently in boys than in girls

Signs and Symptoms yHigh arched foot that may have a crease-cross of the sole of the foot yThe heel is drawn up yThe toes are pointed down yThe bottom of the feet (heel) is pointed away from the body, thus the foot is twisted in towards the other foot

yThe foot and leg

may be smaller yThe foot will lack motion and be noticeably stiff yThe calf muscle may be smaller

Pathophysiology Genetic, sex, maternal illness Lifestyle, presentation Arrest in fetal development of skeletal and soft tissues during 9 to 10 weeks of gestation

Defective cartilage with ligaments laxity Shortening of medial cartilage Clubfoot

Diagnostic Test
yPhysical exam yUltrasound yX-ray

Medical Management 1. Exercises 2. Manipulation and Casting (cast is changed perodically to change angle of foot) 3. Denis brown splint (bar shoe): metal bar with shoes attached to the bar at specific angle

4. Surgery yTenotomy (needed in 80% of cases) is a release (clipping) of the


usually done 9 to 12 months

archilles tendon minor surgery

yAnterior Tibial Tendon Transfer (needed


in 20% of cases) where the tendon is moved from the first ray (toe) to the third ray in order to release the inward traction on the foot

Nursing intervention yPerform exercises as ordered. yProvide cast care or care for a child in a brace. yChild who is learning to walk must be prevented from trying to stand; apply restraints as necessary. yProvide diversional activities.

5. Adapt care routines as needed for cast or barce. 6. Assess toes to be sure cast it not too toght. 7. Provide skin care.

Prognosis The long-term prognosis for babies with clubfoot who were treated with the Ponseti Method is excellent. They have had almost no difference in function or pain in their feet when compared to those persons who were born without clubfoot.

Complication A number of secondary deformities may develop in the foot later in life. It is not always clear why these develop, but may be a combination of post-surgical overcorrection & intrinsic problems. These new deformities may include:

yValgus Hindfoot.
relation to the leg.

The heel tilts outward in relation to the leg.

yCalcaneus at increased

angle - the heel is too vertical in

yDecrease in longitudinal arch -

collapsed arch yPersistent rolling of the ankle ySevere residual clubfoot deformity.