Club foot presentation definition and more details

An overview on club foot

1. Club&Flat Foot Amir Yasin

2. Club Foot Clubfoot, also known as congenital talipes equinovarus , is a common idiopathic deformity of the foot that presents in neonates .  Tuesday, February 2, 20XX Sample Footer Text 2

3. 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 Tuesday, February 2, 20XX Sample Footer Text 3

4. Definitions 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. Tuesday, February 2, 20XX Sample Footer Text 4

5. Epidemiology most common musculoskeletal birth defect overall incidence 1:1,000, though some populations 1:250 highest prevalence in Hawaiians and Maoris male:female ratio approximately 2:1 Tuesday, February 2, 20XX Sample Footer Text 5

6. Etiology Genetics genetic component is strongly suggested unaffected parents with affected child have 2.5% - 6.5% chance of having another child with a clubfoot familial occurrence in 25% recent link to PITX1, transcription factor critical for limb development Tuesday, February 2, 20XX Sample Footer Text 6

7. Risk Factors Family history Smoking during pregnancy Gender male to female 2:1 No enough amniotic fluid during pregnancy Getting an infection or using illicit drugs during pregnancy Tuesday, February 2, 20XX Sample Footer Text 7

8. Types Talipus varus : inversion or bending inward of foot. Talipes valgus : version or bending outward of foot. Talipes equinus : planter flexion and toe is lowe than heel. Talipes calcaneous : dorsiflexion, toe is higher than heel. Tuesday, February 2, 20XX Sample Footer Text 8

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10. muscle contractures contribute to the characteristic deformity that includes (CAVE) : Cavus  (tight intrinsics, FHL, FDL) Adductus of forefoot (tight tibialis posterior) Varus  (tight tendoachilles , tibialis posterior, tibialis anterior) Equinus  (tight tendoachilles ) bony deformity consists of medial spin of the midfoot and forefoot relative to the hindfoot talar neck is medially and plantarly deviated calcaneus is in varus and rotated medially around talus navicular and cuboid are displaced medially Tuesday, February 2, 20XX Sample Footer Text

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12. Presentation Inspection small foot and calf   shortened tibia medial and posterior foot skin creases hindfoot in  equinus and varus midfoot in  cavus forefoot in adduction Tuesday, February 2, 20XX Sample Footer Text 12

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14. Imaging Ultrasound  clubfoot sometimes diagnosed in utero 1st trimester associated anomalies, including non-musculoskeletal ones, are very common in children diagnosed with clubfoot in the first trimester 2nd trimester these are typically true clubfeet, but associated anomalies are less common 3rd trimester if clubfoot first diagnosed in 3rd trimester, the false positive rate is higher due to higher probability of intrauterine crowding Tuesday, February 2, 20XX Sample Footer Text 14

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16. Radiographs(often not taken) Recommend views if taken Dorsiflexion lateral : Will show hindfoot parallelism between the talus and calcaneus will see  talocalcaneal angle < 25° may see flat talar head in older children, but not in infants AP: talocalcaneal (Kite) angle is < 20° (normal is 20-40°)  talus-first metatarsal angle is negative (normal is 0-20°) -- talus points lateral to first metatarsl also shows hindfoot parallelism Tuesday, February 2, 20XX Sample Footer Text 16

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18. Tratement Nonoperative: Ponseti method of serial manipulation and casting    Ponseti method is the gold standard in most of the world this is the standard of care for untreated clubfeet Ponseti method has a > 90% success rate in avoiding comprehensive surgical release children can be expected to walk, run and be fully active in the absence of other comorbidities  

19. French method of daily physical therapy, manipulation and splinting rarely used in the United States good outcomes in skilled hands Tuesday, February 2, 20XX Sample Footer Text 19

20. Operative posteromedial soft tissue release   and tendon lengthening medial column lengthening or lateral column-shortening osteotomy, or cuboid decancellation Talectomy multi-planar supramalleolar osteotomy ring fixator (Taylor Spatial Frame) application and gradual correction triple arthrodesis Tuesday, February 2, 20XX Sample Footer Text 20

21. posteromedial soft tissue release   and tendon lengthening indications resistant and/or recurrent feet in young children which have failed Ponseti casting and bracing "rocker bottom" feet that develop following serial casting which failed non-surgical intervention  syndrome-associated clubfoot if casting fails when performed, it is often done at 9-10 months of age in non-syndromic feet so walking is not delayed outcomes requires postoperative casting for optimal results long-term stiffness and pain are relatively common extent of soft-tissue release correlates inversely with long-term function of the foot and patient Tuesday, February 2, 20XX Sample Footer Text 21

22. medial column lengthening or lateral column-shortening osteotomy, or cuboid decancellation indications often combined with initial surgical clubfoot release in children more than 2-3 years old may be performed in 3-10 years old children with recurrent deformity and "bean-shaped" foot Tuesday, February 2, 20XX Sample Footer Text 22

23. Talectomy indications in severe, rigid recurrent clubfoot in children with arthrogryposis age typically 6-10 years Tuesday, February 2, 20XX Sample Footer Text 23

24. multi-planar supramalleolar osteotomy indications rarely necessary salvage procedure in older children with complex, rigid, multiplanar clubfoot deformities that have failed conventional operative management salvage procedure in older children (8-10 yrs) with an insensate foot Tuesday, February 2, 20XX Sample Footer Text 24

25. ring fixator (Taylor Spatial Frame) application and gradual correction indications complex deformity resistant to standard methods of treatment recurrence of deformity is very high after frame removal Tuesday, February 2, 20XX Sample Footer Text 25

26. triple arthrodesis indications almost never indicated contraindicated in insensate feet due to rigidity and resultant ulceration Tuesday, February 2, 20XX Sample Footer Text 26