Club foot POC report

8/8/2019 Club foot POC report

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Presented by: Philip C. Centeno

Group CB30


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` Aclubfoot, or congenital talipes equinovarus (CTEV), is

a congenital deformity involving one foot or both.The

affected foot appears rotated internally at the ankle. It is

classified into 2 groups: Postural TEV or Structural TEV.

Without treatment, persons afflicted often appear to walkon their ankles, or on the sides of their feet. It is a

common birth defect, occurring in about one in every

1,000 live births.


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` The deformities affecting joints of the foot occur at three joints of the

foot to varying degrees. They are:

` Inversion at subtalar joint


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` Adduction at talonavicular joint:


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` Equinus at ankle joint


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` Talipes may be positional or structural.

` Positional talipes is caused by abnormal pressures

compressing the foot while it's developing, as a result of its

position in the womb.

` Structural talipes is a more complex condition and caused bya combination of factors, such as a genetic predisposition.

Structural TEV is caused by genetic factors such as Edwards

syndrome, a genetic defect with three copies of chromosome

18. Growth arrests at roughly 9 weeks and compartment

syndrome of the affected limb are also causes of StructuralTEV.


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` It may also result from a condition called

oligohydramnios, where there's a shortage of

amniotic fluid around the baby in the womb.

` One in 1,000 babies is born with talipes. It's twiceas common in boys than in girls. A genetic

predisposition means it tends to run in families.


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` Clubfoot is treated by manipulation. It is done byproviding braces to hold the feet in orthodoxpositions, serial casting, or splints called kneeankle foot orthoses (KAFO).

` In NorthAmerica, manipulation is followed byserial casting, most often by the Ponseti Method.Foot manipulations usually begin within two weeksof birth. Even with successful treatment, when

only one side is affected, that foot may be smallerthan the other.


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` Ponseti Method Applies certain techniques to

reduce and correct the deformity to promote

normal foot mobility and position. Methods used

are the following:` Manipulation - Slightly pivoting the bones and

stretching the soft tissue

` Placement of above the knee cast Frequency of changing the cast is every 5-7 days to

accommodate the rapid growth during the first year of

life.


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In most cases, severing ofAchilles tendon (tenotomy)

is done before the final cast is applied. The reason for

doing this is to loosen the foot. The procedure is

usually done in a clinic where a local anesthetic is

used.A small cut (about 3 mm) is made above the heel

of thefoot to lengthen the tendon.After the procedure

final casting is done.

Final cast is removed after 2-3 weeks whenAchillestendon is already healed.


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After the final cast is removed:

` Denis Brown Splints (shoes or boots attached to a bar)

are used 23 hours each day for 3 months to maintain the

normal foot alignment. For the next 2-4 years the splint

is fitted during naps and nighttime only.

` Passive foot exercises (full range-of-motion) are

executed by the primary caregiver to further maintain the

position.


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Documents

Club foot POC report