3. Clubfoot, also known as Congenital Talipes Equino
varus, is a complex, congenital deformity of the foot.
C Cavus (increased longitudinal arch of the feet)
A Adduction (tarsal bones directed towards the
median plane)
V Varus (inversion and adduction of the calcaneal
bones)
E Equinus (increased plantar flexion of the ankles)
Introduction
5. DEFINITION
It is defined as a deformity characterized by
complex, malalignment of the foot involving soft
and bony structures in the hind foot, mid foot and
forefoot.
Clubfoot is a congenital foot deformity that
affects the bones, muscles, tendons, and blood
vessels in a childs foot
It is usually present at birth and can range
from mild to severe
6. It is the most common congenital malformation
of the foot affecting 1-2 newborns per 1000.
It is twice as common in males than females.
Clubfoot may be unilateral (30%-40%) one or
bilateral (60%-70%).
A normally developing foot turns into a club foot
during 2nd
trimester of pregnancy.
Rarely detect with USG before 16th
week.
EPIDEMIOLOGY
8. SIGN AND SYMPTOMS
The physical appearance of the clubfoot may also vary. One or
both feet may be affected.
Feet turning inwards
Tightness in the calf muscles
The foot has decreased joint range of the movement.
Resting of the foot on its outer border
Rigidity and other changes in the movement of the foot
9. COMPLICATIONS
Clubfoot typically doesn't cause any problems until your child starts to stand
and walk. If the clubfoot is treated, your child will most likely walk fairly
normally. He or she may have some difficulty with:
Movement. The affected foot may be slightly less flexible.
Leg length. The affected leg may be slightly shorter, but generally does not
cause significant problems with mobility.
Calf size. The muscles of the calf on the affected side may always be smaller
than those on the other side.
Arthritis. Your child is likely to develop arthritis.
10. DIAGNOSIS
Clubfoot is usually detected antenatal by
ultrasound scan- to detect muscular & osseous involvement
at birth- The examination after birth consists of taking the foot and manipulating it
gently to see if it can be brought into normal position. If not, there is a positive
diagnosis of clubfoot.
Plain X-ray- of the affected foot AP and lateral views helps to assess various
angles to assess the extend of deformity.
11. TREATMENT
Clubfoot treatment includes several methods. Your care team will discuss the options
with you and figure out which works best for your child. Treatments include:
Ponseti method: Stretches and casts on your childs leg to correct the curve.
French method: Stretches and splints on their leg to correct the curve.
Bracing: Uses special shoes to keep their foot at the proper angle.
Surgery: May be an option if other methods dont work.
12. PT TREATMENT
Physical therapy for Club Foot will be used to stretch the structures of the foot
including the tendons, ligaments, and muscles to adjust the foot and keep it in
the proper position. If surgery is needed, physical therapy will be initiated after
the procedure to ensure that the correction takes hold.
Bracing will be a critical component of recovery from a fixed Club Foot.
Manual therapeutic technique (MTT)
Hands on care including soft tissue massage, stretching and
joint mobilization by a physical therapist to improve
alignment, mobility and range of motion of the foot. The use
of mobilization techniques also helps to modulate pain.
13. Therapeutic Techniques
Including stretching and strengthening exercises to regain range of motion and
strengthen muscles of the foot and lower extremity to support.
Taping Technique is Also Useful.
To restore stability, retrain the lower extremity and improve
movement techniques and mechanics (for example, walking,
gait training, running or jumping) of the involved lower
extremity to reduce stress on the joint surfaces in daily
activities.
Rhythmic and repeated gentle manipulation.
Strapping and plaster of Paris (POP) cast.
Education and instructions to the mother and/or parents.
Modalities including the use of ultrasound, electrical
stimulation, ice, cold, laser and others to decrease pain and
inflammation of the involved joint.
15. SURGICAL TREATMENT
Sometimes, a child has severe clubfoot. Or youve tried nonsurgical methods, but
they havent worked. Surgery can correct the problem. Its best if your child has
the surgery before they start walking. During the procedure, the surgeon:
Lengthens your babys heel cord and fixes other problems with their foot or
feet.
Places pins in their foot to correct the position.
Puts a cast on their foot after the surgery.
17. A few weeks after the surgery, the surgeon:
Removes the cast and pins.
Puts a new cast on your childs foot, which your child wears for about another
four weeks.
Removes the final cast.
Theres still a chance their foot could return to the clubfoot position. Your
provider may recommend bracing or special shoes to keep their foot in the
correct position.
18. TREATMENT BY EXTERNAL
FIXATORS
There are two types of external fixator frame-
One is Designed by Ilizarov, a Russian orthopedic surgeon
The second one is designed by an Indian orthopedic surgeon, BB Joshi. This
frame is known as Joshis external stabilization system popularly called JESS.
19. SPLINT
Is a device used for holding a part of the body stable to decrease pain and
prevent further injury.
