CLUB FOOT (TALIPES EQUINOVARUS) A clubfoot deformity involves the entire leg, not just the foot. It affects 1 in 1000 newborns and is bilateral in one half of the cases. The tarsals in the affected foot are hypoplastic; the talus is most affected. The muscles of the limb are hypoplastic because of the abnormal tarsal interactions, which leads to a generalized limb hypoplasia, mainly affecting and shortening the foot. There is usually atrophy of the calf musculature. Etiology Family history is important. Club foot can be congenital, teratologic, or positional. Congenital clubfoot (75% of all cases) is usually an isolated abnormality. Teratologic clubfoot is associated with a neuromuscular disorder, such as myelomeningocele, arthrogryposis, or other syndromes. Positional clubfoot is a normal foot that was held in the deformed position in utero. Clinical Manifestations The diagnosis is seldom confused with other disorders (Fig. 201-1). The presence of clubfoot should prompt a careful search for other abnormalities. The infant will have hindfoot equinus and varus, forefoot adduction, and varying degrees of rigidity. All are secondary to the abnormalities of the talonavicular joint. Calf atrophy and foot shortening are more noticeable in older children. Radiologic Evaluation In infants, radiographs and advanced imaging are rarely necessary for assessment since their tarsals have incomplete ossification. The navicular ossifies at about 3 years of age for girls and 4 years for boys. As children age, radiographs can be used to follow the tibial calcaneal and lateral talocalcaneal angles and to assess navicular positioning. Treatment The goal of treatment is to correct the deformity and preserve mobility. Nonoperative treatment involves the Ponseti method of serial casting. The Ponseti method also relies on a percutaneous tenotomy of the Achilles tendon to help correct the equinus deformity. About 20% of patients will require an anterior tibialis tendon transfer in early childhood. Rarely, more aggressive surgical procedures may need to be done. Complications of untreated clubfoot include severe disability. Complications of treated clubfoot include recurrence and stiffness.
Posted on: Sat, 15 Mar 2014 03:06:14 +0000
Trending Topics
Recently Viewed Topics
© 2015