CLUB FOOT
A club
foot or clubfoot, also called congenital talipes equinovarus(CTEV)
Most types of clubfoot are present at birth
(congenital clubfoot). Clubfoot can happen in one foot or in
both feet. In almost half of affected infants, both feet are involved.
The affected foot appears to have been rotated
internally at the ankle. 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 recovers completely
during early childhood and is able to walk and participate in athletics as well
as patients born without CTEV.
It is important to remember that although it is a
painless condition at birth, club foot can worsen with time. If left untreated, the child may begin walking on the outer
surface of the foot and the toes.
Congenital talipes equinovarus (CTEV) or
clubfoot is a common foot abnormality found in males generally present at
birth. In babies with clubfoot the tissues connecting the muscles to the bones
are shorter than usual causing their feet to be twisted. The ankle can be twisted
at a sharp angle making the foot resemble a golf club, hence the name. The
severity of clubfoot can range from mild to severe with half of affected babies
having both feet affected.
Definition- club foot is complex
deformity of foot result of complicated interrelationship between bone,
ligament and muscles.
Terms-
Talipus-foot and ankle
Varus-bending inwards
Valgus-bending outwards
Equinus-toes are lower than heel
Calcaneous-toes are higher than heel
What causes clubfoot?
·
Position of baby in womb during pregnancy
·
Genetic factor(defective gene)
·
Mechanical cause(uterine compression)
·
Circulatory failure to calf and foot muscles
·
Environmental factors
·
If your family has one child with clubfoot, the chances of a
second infant having the condition increase.
·
Clubfoot can also be the result of problems that affect the nerve,
muscle, and bone systems, such as stroke or brain injury.
Sign & Symptoms –
Each of the following characteristics may be present, and each may
vary from mild to severe:
·
The foot (especially the heel) is usually smaller than normal.
·
The foot may point downward.
·
The person not able to walk properly
·
Gait become affected
·
No balance on body part
- Abnormal shape of the
foot
- Rigidity and other
changes in the movements of the foot
·
The front of the foot may be rotated toward the other foot.
·
The foot may turn in, and in extreme cases, the bottom of the foot
can point up.
Other symptoms of clubfoot?
Clubfoot is painless in a baby,
but it can eventually cause discomfort and become a noticeable disability. Left
untreated, clubfoot does not straighten itself out. The foot will remain
twisted out of shape, and the affected leg may be shorter and smaller than the
other. These symptoms become more obvious and more of a problem as the child
grows. There are also problems with fitting shoes and participating in normal
play. Treatment that begins shortly after birth can help overcome these
problems.
Classification-
Talipus equinovarus- 95%
of cases in this condition the foot is fixed in planter flexion and
deviates medially. If condition is not treated the child walks on toes and
outer boarder of the foot. The heel is elevated.
Talipus calcaneovalgus- in this foot is dorsiflexed and deviates laterally.
The heel is turned outward from the midline of the body and the anterior part
of the foot is elevated on the outer border. If not corrected the child walks
on outward turned heel and inner border of foot. These condition may be
unilateral or bilateral.
Other are less common types-
Talipus varus- due
to the heels being turned inward from midline of leg. Only the outer portion of
sole rests on the floor.
Talipus Valgus- due to the heels being turned outward from
midline of leg. Only the inner side of sole rests on the floor.
Talipus equinovalgus- due to the heels being elevated and turned outward from midline of body.
In this condition the foot is fixed in plantar flexion and
deviates medially, the heel is elevated, the child walks on the toes and the
outer border of the foot.
Talipes calcaneovarus- due to the heels being turned towards the
midline of the body and the anterior part of the foot being elevated. Only the heels rests on the
floor.
Talipes calcaneovalgus - in this the food is dorsiflexed and
deviates laterally , the heel is anterior part of the foot is elevated on the
outer border, the child is walk on the outwardly turned heel and the inner
border of the foot............
Diagnosis-
Physical examination
X ray
Treatment-
Initial -Nonoperative
Serial manipulation followed by immobilization in a plaster
cast, taping or strapping started at the time of diagnosis. Cast changes are
usually done on a weekly basis. After the initial period approximately 3 months
of casting, evaluation is performed to determine whether to continue with
manipulation and casting, perform a percutaneous tenotomy or proceed to use of
corrective shoes with or without a Dennis-Browne bar or the more recent Wheaton
Brace or Bebax shoe. A
Denis Browne brace. Various types of foot-abduction braces are used to hold the
child's feet in the desired position
French Method
The
French method, also known as the "functional method" or
"physiotherapy method", is easiest to do with young bones. A physical
therapist will direct parents to stretch and tape their child's foot. Little by
little move the child’s foot to achieve the right position then hold it in
place with tape.
Surgical repair-
On occasion, stretching,
casting and bracing are not enough to correct a child's clubfoot. Surgery may
be needed to adjust the tendons, ligaments and joints in the foot/ankle.
Usually done at 9 to 12 months of age; surgery usually corrects all clubfoot
deformities at the same time. After surgery, a cast holds the clubfoot still
while it heals.
Nurse’s role-
·
Explain
child and parent about disease
·
Instruct
about care of plaster cast
·
Tell about
Denis brown shoes and its importance
·
Avoid abnormal position of foot and ankle
·
Support the foot after surgery with cast or club foot shoes
·
Keep the casted extremity elevated to prevent edema.
·
Check circulation frequently each 2 hours
·
Assess for color, warmth, presence of pedal pulses and sensations of
numbness or tingling.
·
Turn the
child every 2 hr to allow the under surface of the cast to dry.
·
Do not use
heaters or fans to dry the cast as it causes uneven drying.
Physical care-
1. Maintain appropriate muscle
tone
2. Provision of comfort
3. Traction/ Cast care
4. Prevention of urinary stasis
and constipation
5. Promotion of skin integrity
Parent teaching
• How to apply devices such as
Denis Brown splint.
• Explain the procedure
• Teaching of diversional therapy
during application of traction/cast
• Caring of cast? (Wet, how to
dry)
• Assess for circulatory and
neurological disturbance
No comments:
Post a Comment