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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Clubfoot

Clubfoot is a congenital condition in which the foot turns inwards and down. The condition is termed clubfoot because the position of the feet resemble the head of a golf club. It is the most common congenital disorder of the legs, ranging from mild and flexible to severe and rigid. The cause of clubfoot is unknown but there seems to be a hereditary basis in some cases. Your baby's chance of having a clubfoot are twice as likely if you, your spouse or other children have the condition. Risk factors include a family history of clubfoot and being male. Clubfoot affects 1 in every 1,000 children born (A.D.A.M, 2011; Livestrong.com, 2011).

Types of clubfoot:

There are 4 types of defects, that are jointly known as 'talipes'. Talipes is the medical term given for a congenital deformity of the foot, marked by a curled shape or the twisted position of the ankle, heel and toes.

  •  The most common form of talipes is 'Congenital Talipes Equinovarus' (CTEV), more commonly referred to as clubfoot. Children with this condition, as stated above, are born with their foot pointing downwards and twisted inwards at the ankle. This is the most severe type in that the child is unable to walk with their sole flat on the ground, but  must walk on the ball, the side or even the top of the foot.
  •  Talipes equinovalgus occurs when the foot points outwards and downwards.
  •  Talipes calcaneovarus is diagnosed if the foot points inwards and upwards.
  •  Talipes calcaneovalgus occurs when the foot points inwards and down.(babyworld.co.uk; clubfoot club.org).

Causes:

More severe cases of clubfoot are generally associated with other abnormalities or problems, such as spinal dysraphism, tethered cord, etc. Milder cases are often called 'idiopathic' because the cause is unknown. The appearance of the foot at birth does resemble the foot during early fetal development, it is therefore assumed that some unknown factor halts the change of the foot position during normal fetal growth. A condition known as oligohydramnios, whereby there is too little fluid surrounding the baby, has also been implicated as a factor in talipes (babyworld.co.uk; epodiatry.com).

Symptoms:

The symptoms of clubfoot are mostly due to the position of the feet. Untreated clubfoot can result in corns, hard, calloused skin and ingrown toenails when your child starts walking. 49% of cases of clubfoot are bilateral, i.e. involving both feet. As a result, the muscles in both calves may be underdeveloped, causing the legs and feet to appear smaller. Where only 1 foot is involved, the affected leg can be significantly shorter than the non-affected side, resulting in an unusual gait. Clubfoot can occur together with other neuromuscular disorders and is therefore known as syndromic clubfoot. Eg children with spina bifida or a malformation of the bones in the spine, often have clubfoot. They exhibit symptoms including neurologic impairment that may be serious enough to cause seizures, bladder and bowel impairment or paralysis (Livestrong.com, 2011).

Diagnosis:

Parents know immediately if their child has a clubfoot. Some even know before their child is born, if an ultrasound was done during pregnancy. Clubfoot is diagnosed on the basis of a physical examination. Because CTEV is one of the most common abnormalities at birth, all newborn babies are routinely checked. A foot x-ray may also be performed (A.D.A.M., 2011; The American Academy of Orthopaedic Surgeons, 1995-2011).

Treatment:

A clubfoot cannot be straightened simply by moving it around. This type of deformity means that the tendons and ligaments on the inside and back of the foot and ankle are shorter than usual while those on the outside and front are stretched out, resulting in your baby's foot being in an unusual position (Seattle Children's Hospital, 1995-2011).

The objective of clubfoot treatment is to obtain a flexible and plantigrade foot. In other words, to ensure your child can move their foot around freely without pain and that they are able to stand with the sole of their foot on the ground (clubfootclub.org).

1) Non-surgical treatment- In order to have a successful outcome without surgery, treatment needs to begin immediately. A particularly effective method of correcting clubfoot, is known as the Ponseti method. It involves changing your child's cast for several weeks on a weekly basis and stretching the foot towards the correct position. The heel cord is then stretched, followed by the final cast for 3 weeks. The casts extends from the hip to the toes. Once the foot has been corrected, your infant is required to wear a brace at night for 3-4 years. The brace is made up of aluminum shoes, connected to a metal bar, that will turn your child's feet outwards. This requires parental co-operation because without the braces, clubfoot will recur. This is because the muscles around the foot can pull it back into an abnormal position. The aim of this treatment program, is to make your child's clubfoot/feet as functional, painless and stable as possible, for when they are ready to walk (American Academy of Orthopaedic Surgeons, 2005-2011; Seattle Children's Hospital, 2005-2011).

2) Surgical treatment- Occasionally stretching, casting and bracing are not sufficient to correct the problem and surgery is required. This usually occurs between 9-12 months of age and will correct all your child's clubfoot deformities simultaneously. Surgery may involve the adjustment of the tendons, ligaments and joints in the foot or ankle. This is followed by a casting, to hold the clubfoot still while it heals. Special shoes or bracers will be required, for a period of 1 year or more, to prevent a recurrence. Surgery will probably result in a stiffer foot than non-surgical options over time (American Academy of Orthopaedic Surgeons, 2005-2011).

Following treatment, children with clubfeet will require regular assessments of their feet throughout childhood and adolescence until they reach maturity. This is to ensure that the condition has not recurred (clubfootclub.org).

Prognosis:

If left untreated, clubfoot will result in severe functional disability. The deformity will only get worse over time, resulting in the development of secondary bony changes. An uncorrected clubfoot in children and adults is both unsightly and crippling, requiring the patient to walk on the outside of the foot, that is not designed for weight bearing. This causes the skin to break down, resulting in painful ulceration and infection (clubfootclub.org).

With treatment, your child will have a nearly normal foot, allowing them to run and play without pain, and wear normal shoes. However, the corrected clubfoot will not be perfect; remaining somewhat less mobile and 1-1 1/2 sizes smaller, than the normal foot. The calve muscles in your child's clubfoot leg will also remain smaller (American Academy of Orthopaedic Surgeons, 2005-2011).

Complications:

Call your doctor immediately if, your child presents with the following problems or symptoms;

  •  Their toes bleed, swell or change colour under the cast.
  • The cast is causing them significant pain.
  •  Their toes disappear into the cast.
  •  The cast slides off.
  •  Their foot/feet begin to turn inwards again after the treatment (A.D.A.M., 2011).

NB: Any changes in colour or temperature while wearing a cast, may indicate problems in circulation.