Club foot

Club foot is congenital deformity of the foot and ankle,

1. Club foot(Congenital Talipes Equinovarus ) BY: Mr . Ganesh V. Naik II Year MSc (N) Pediatric dept. SDMINS Dharwad

2. INTRODUCTION Talipes Equinovarus is a deformity of the foot and ankle that a child can be born with this problem. The term “ tallipes ” was coined by little in 1839. He derived it from the Latin “Talus”(ankles) and pes ( foot)

3. DEFINITION Clubfoot is a complex deformity of foot result of complicated interrelationship between bone, ligaments and muscles.

4. INCIDENCE It occurs in one out of 1000 live birth. Boys affected twice more than girls

5. CAUSES 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.

6. CLASSIFICATION Talipes Equinovarus : 95% all cases In this condition, the foot is fixed in plantar flexion and deviates medially that is the heal is elevated. If the condition is not corrected , the child walks on the toes and the outer boarder of the foot.

7. Conti.. 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 anteriar 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

8. Conti.. Other less commonly observed types are: Talipes varus : Due to the heel’s being turned inward from the midline of the leg. Only the outer portion of the sole rests on the floor 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

9. Talipes valgus

10. Conti… Talipes Equinovalgus : Due to the heels being elevated and turned outward from the midline of the body. 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.

11. TERMS Talipes : Foot and ankle Varus : Bending inward Valgus : Bending outward Equinus : Toes are lower then heel. Calcaneous : Toes are higher than heel

12. CLINICAL MANIFESTATIONS 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

13. Conti… The calf muscles are generally underdeveloped Stiff rigid, foot of varying degrees.

14. DIAGNOSTIC EVALUATION History collection Physical examination Ultrasound scanning during pregnancy X-rays

15. MANAGEMENT Non operative management: Two catagories of clubfoot are identified. Easy or correctable clubfoot: which is corrected with manipulation , casting and splintage alone. Resistant clubfoot: It is that which responds poorly to splintage and manipulative treatment. It requires operative management

16. Conti… Ponseti method is popular manipulation method to correct clubfoot. This is not painful or uncomfortable for the child. In this method the specialist manipulates(holds, stretches and moves) the child’s foot with their hands into a position in which the foot deformity is put right (corrected) as much as possible. Once in this position plaster cast is put on to hold the child’s foot in position .The whole process may done 4 to 10 times

17. Casting

18. Conti.. 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.

19. Conti.. Nursing management: 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

20. Thank you