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INTRODUCTION
Causes
The cause of clubfoot isn't known (idiopathic). But scientists do know that
clubfoot isn't caused by the position of the fetus in the uterus. In some
cases, clubfoot can be associated with other congenital abnormalities of the
skeleton, such as spina bifida, a serious birth defect that occurs when the
tissue surrounding the developing spinal cord of a fetus doesn't close
properly.
Stages
SYMPTOMS
• If left untreated the child will walk on the outer top surface of the foot.
• The patient may also experience corns, hard skin and in growing
toenails.
• Clubfoot in adulthood can lead to difficulty in purchasing shoes and a
gait abnormality (walking pattern).
Etiology
The true etiology of congenital clubfoot is unknown. Most infants who have
clubfoot have no identifiable genetic, syndromal, or extrinsic cause.7 Extrinsic
associations include teratogenic agents (eg, sodium aminopterin),
oligohydramnios, and congenital constriction rings. Genetic associations
include mendelian inheritance (eg, diastrophic dwarfism; autosomal
recessive pattern of clubfoot inheritance).Cytogenetic abnormalities (eg,
congenital talipes equinovarus [CTEV]) can be seen in syndromes involving
chromosomal deletion. It has been proposed that idiopathic CTEV in
otherwise healthy infants is the result of a multifactorial system of
inheritance. Evidence for this is as follows:
TREATMENTS
There are many treatments available for clubfoot and many different
opinions exist concerning treatment regimes.
Casting
A series of plaster or fiberglass casts are applied to the foot and lower limb –
these are replaced every few weeks, which each cast progressively moving
the foot towards a more corrected position. The number of times the cast
needs to be replaced will be determined by the severity of theclubfoot (but
several months is not unusual). Most activities are not hampered by wearing
a cast.
• This may be begin from the 1st day of life to several weeks after birth.
• The foot is pushed and twisted into an over corrected position by the
Orthopedist. The cast is then applied in order to hold the foot into that
position. This may be uncomfortable for the child.
• Casts are usually changed every two weeks.
• Splints or braces may be used after a few years of casting the feet.
This above photo of an infant in a Denis Browne bracing bar after undergoing
months of casting using the Ponseti method as treatment for his bilateral
clubfeet.
He will have to wear the bracing bar for 23 hours a day for about 3 months
and then only at night for two to four years.
Surgery
There are many surgical procedures available for clubfoot. Surgery is usually
recommended to a child of six months old. Below are the list of commonly
used surgical procedures. For further information concerning these surgical
procedures, please consult an Orthopedist.
Contraindications