Club foot

Nursing Presentation.

1. CLUB FOOT Presented By :- Sushant

2. INTRODUCTION Talipes :- Latin talus (ankle) + pes (foot). Equino :- indicates the heel is elevated (like a horse's) varus :- indicates it is turned inward. It is a congenital malformation of the lower extremity that affects the lower leg, ankle, and foot. Club foot, also called congenital talipes equinovarus (CTEV), is a congenital deformity involving one foot or both. The affected foot appears to have been rotated internally at the ankle.

3. Without treatment, people with club feet often appear to walk on their ankles or on the sides of their feet. However with treatment, the vast majority of patients recover completely during early childhood and are able to walk and participate in athletics. Approximately half of people with clubfoot have it affect both feet, which is called bilateral club foot. It occurs in males twice as frequently as in females. Because of poverty, lack of education and socioeconomic reasons many of our children (more than 60%) are neglected and remain untreated.

4. 3 basic components:- ( i ) ankle joint plantarflexed /equines (ii) subtalar joint inverted/ varus (iii) forefoot adducted Mainly three bones are affected ; 1.TALUS 2.CALCANEUS 3.NAVICULAR

5. By the time we detect them during camps, they are already grown up (5 to 18 years of their life). With this age bones are deformed to great extent and deformities become severe and rigid which are difficult to correct. Also there is a large group of children who get inadequate treatment and deformities recur. 3 basic components :- ( i ) ankle joint plantarflexed /equines (ii) subtalar joint inverted/ varus (iii) forefoot adducted

6. INCIDENCE The overall prevalence of clubfoot was 1.29 per 1,000 live births, with 1.38 among non-Hispanic whites, 1.30 among Hispanics, and 1.14 among non-Hispanic blacks or African Americans. In India, out of those children who have born with this deformity only 20- 25% of children from urban areas, get proper care and treatment and get cured of the disease. Rest of the children either remains untreated (neglected); or even if some of them are treated, they get recurrences and remain disabled for the life. children with clubfoot born per year: 30,000( india )

7. DEFINITION Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which a baby's foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual. The term "clubfoot" refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Despite its look, however, clubfoot itself doesn't cause any discomfort or pain.

8. Infant with unilateral clubfoot Infant with bilateral clubfoot

9. CAUSES The cause of clubfoot is unknown (idiopathic). But scientists do know that clubfoot is not caused by the position of the baby in the womb (fetus). In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida. Clubfoot can also be the result of problems that affect the nerve, muscle, and bone systems, such as stroke or brain injury. Extrinsic associations include teratogenic agents ( eg , sodium aminopterin ), oligohydramnios , and congenital constriction rings

10. It has been proposed that idiopathic CTEV in otherwise healthy infants is the result of a multifactorial system of inheritance . syndromes involving chromosomal deletion. The environment plays a role in causing clubfoot. Studies have strongly linked clubfoot to cigarette smoking during pregnancy, especially when there already is a family history of clubfoot. Causes…..

11. RISK FACTORS Risk factors include: Sex. Clubfoot is more common in males. Family history. If either one of the parents or their other children have had clubfoot, the baby is more likely to have it as well. It's also more common if the baby has another birth defect. Smoking during pregnancy. If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of the condition may be 20 times greater than average.

12. Risk factors…… Not enough amniotic fluid during pregnancy. Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot. Getting an infection or using illicit drugs during pregnancy. These can increase the risk of clubfoot as well.

13. types Talipus varus : inversion or bending inward of foot. Talipes valgus : eversion or bending outward of foot. Talipes equinus : planter flexion and toe is lowe than heel. Talipes calcaneous : dorsiflexion , toe is higher than heel. Treatment requires stretching: plantarflex and invert foot, excellent prognosis

14. SYMPTOMS If a child has clubfoot, his or her foot may have the following appearance: The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward. The foot may be turned so severely that it actually looks as if it's upside down. The calf muscles in the affected leg are usually underdeveloped. The affected foot may be up to 1/2 inch (about 1 centimeter) shorter than the other foot.

15. COMPLICATIONs Clubfoot typically doesn't cause any problems until a child starts to stand and walk. If the clubfoot is treated, the child will most likely walk fairly normally. He or she may have some difficulty with: Mobility. The child's mobility may be slightly limited. Shoe size. The affected foot may be up to 1 1/2 shoe sizes smaller than the unaffected foot.

16. However, if untreated, clubfoot causes more-serious problems. These can include: Arthritis. The child is likely to develop arthritis. Poor self-image. The unusual appearance of the foot may make the child's body image a concern during the teen years. Inability to walk normally. The twist of the ankle may not allow the child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases. Muscle development problems. These walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the feet, and result in an awkward gait.

17. DIAGNOSIS Most commonly, a doctor recognizes clubfoot soon after birth just from looking at the shape and positioning of the newborn's feet. Occasionally, the doctor may request X-rays to fully understand how severe the clubfoot is, but usually X-rays are not necessary. It's possible to clearly see some cases of clubfoot before birth during a baby's ultrasound examination. If clubfoot affects both feet, it's more likely to be seen in an ultrasound. While nothing can be done before birth to solve the problem, knowing about the condition may give time to learn more about clubfoot and get in touch with appropriate health experts, such as a genetic counselor or an orthopedic surgeon.

18. TREATMENT As the newborn's bones and joints are extremely flexible, nonsurgical treatments such as casting or splinting are usually tried first. The foot (or feet) is moved (manipulated) into the most normal position possible and held (immobilized) in that position until the next treatment. This manipulation and immobilization procedure is repeated every 1 to 2 weeks for 2 to 4 months, moving the foot a little closer, to a normal position each time. The goal of treatment is to improve the way the child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities. Treatment options include:

19. 1. Stretching and casting ( Ponseti method) This is the most common treatment for clubfoot. The doctor will do the following: Move the baby's foot into a correct position and then place it in a cast to hold it in that position . Reposition and recast the baby's foot once or twice a week for several months . Perform a minor surgical procedure to lengthen the Achilles tendon ( percutaneous Achilles tenotomy ) toward the end of this process .

20. Percutaneous Achilles tenotomy Casting

21. Other braces & casts…..

22. Wheaton Brace Dennis Brown Bar

23. 2 . Stretching and taping (French method) This approach is also called the functional method or the physiotherapy method. Working with a physical therapist, parents: Move the foot daily and hold it in position with adhesive tape . Use a machine to continuously move the baby's foot while he or she sleeps . After two months, cut treatment back to three times a week until the baby is 6 months old . Once the shape is corrected, continue to perform daily exercises and use night splints until the baby is of walking age . This method requires a much greater time commitment than does the Ponseti method. Some caregivers combine the French method and the Ponseti method.

24. Surgery In some cases, when clubfoot is severe or doesn't respond to nonsurgical treatments, babies may need more invasive surgery. An orthopedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, the child will be in a cast for up to two months, and then need to wear a brace for a year or so to prevent the clubfoot from coming back. Even with treatment, clubfoot may not be totally correctable. But in most cases babies who are treated early grow up to wear ordinary shoes and lead normal, active lives. Usually done at 9 to 12 months of age.

25. PREVENTION Because doctors don't know what causes clubfoot, we can't completely prevent it. However, during pregnancy, things to limit baby's risk of birth defects, include: not smoking or spending time in smoky environments not drinking alcohol avoiding drugs not approved by your doctor

26. Nursing management Postoperative nursing considerations:- Neurovascular checks at least every 2 hours Observe for any swelling around cast edges Elevate ankle and foot on pillows Pain management (analgesics)

27. Doing stretching exercises with baby. Putting child in special shoes and braces. Making sure the child wears the shoes and braces as long as needed — usually full time for three months, and then at night for up to three years .

28. summary

29. bibliography http://www.webmd.com/a-to-z-guides/clubfoot-topic-overview http://www.webmd.com/a-to-z-guides/clubfoot-topic-overview?page=2 http://en.wikipedia.org/wiki/Club_foot http://www.mayoclinic.org/diseases-conditions/clubfoot/basics/

30. Thank you