14
Congenital Talipes Equinovarus (Club Foot) Donald A. Manuain 11-2012-175

Congenital Talipes Equinovalrus (Club Foot)

Embed Size (px)

Citation preview

Page 1: Congenital Talipes Equinovalrus (Club Foot)

Congenital Talipes Equinovarus (Club

Foot)Donald A. Manuain

11-2012-175

Page 2: Congenital Talipes Equinovalrus (Club Foot)

Clubfoot is the most important congenital abnormality of the foot.

It is easy to diagnose but difficult to correct. Consist of a combination of deformities:

◦ Forefoot adduction and supination through midtarsal joint.

◦ Heel varus through the subtalar joint.◦ Equinus through the ankle joint.◦ Medial deviation of whole foot in relation to the

knee.

Overview

Page 3: Congenital Talipes Equinovalrus (Club Foot)
Page 4: Congenital Talipes Equinovalrus (Club Foot)

1-2 in 1.000 live births. Bilateral in one third of the afflicted

children. Affect boys twice as often as girls. Genetic factor in 10% of the children. IF one parent and one child have clubfoot

1 in 4 chances the subsequent child being afflected.

Incidence

Page 5: Congenital Talipes Equinovalrus (Club Foot)

Etiology remains questionable, but the possible cause is neuromuscular defect.◦ The muscle on the posterior and medial aspect of

the leg (calf muscle and the tibialis posterior) are short.

◦ The fibrous capsules of all the deformed joints are thick and contracted.

◦ This contractures become resistant to correction as the time goes by.

Etiology and Pathology

Page 6: Congenital Talipes Equinovalrus (Club Foot)

Mild clubfoot must be distinguished from positional equinovarus.

Teratologic type of severe clubfoot deformity usually associated with spina bifida.

Diagnosis

Page 7: Congenital Talipes Equinovalrus (Club Foot)

General treatment include:◦ Gentle passive correction of the deformities.◦ Maintenance of correction for a long period of

time.◦ Supervision of the child until the end of growth.

Possible recurrence of deformity should be watched for and treated.

Treatment

Page 8: Congenital Talipes Equinovalrus (Club Foot)

Outflare boots are used for day wear until the child is 3 years of age.

Dennis Brown type boot splint or articulated AFO to be worn day and night (3 months).

Dennis Brown type of clubfoot splint by adhesive tape (8 weeks)

Plaster cast applied weekly (6 weeks)

General Plan of Treatment

Page 9: Congenital Talipes Equinovalrus (Club Foot)
Page 10: Congenital Talipes Equinovalrus (Club Foot)

Approx. 40 % of congenital clubfeet treated early by these method will responds in 3-4 months of treatment.

Remaining 60% are resistant to these methods.◦ Continuation leads to failure, because of persistent

incomplete correction or recurrence of deformity.◦ Immobilization pressure necrosis in joint cartilage.

Operative treatment is a meticulous soft tissue correction of all tendon and joint contractures at 4 to 6 months.

Treatment

Page 11: Congenital Talipes Equinovalrus (Club Foot)

Principal: Complete release of the joint (capsular and

ligamentous contractures and fibrotic bands).

Lengthening of the tendons so the foot can be positioned normally.

Opeative Treatment

Page 12: Congenital Talipes Equinovalrus (Club Foot)

Post op, non operative plan is resumed to maintain the correction.

Neglected clubfeet and recurrent clubfeet always require operative treatment.

Soft tissue operation are effective in the first 5 years of life and become less effective in older children.◦ In older children, bone operation (arthrodesis of

the subtalar and midtarsal joint) use to correct any residual deform. until 10 years of age.

Treatment

Page 13: Congenital Talipes Equinovalrus (Club Foot)

40 % patients have satisfactory result from early non operative treatment.

Complete surgical correction for resistant clubfeet at 3-4 months of age make a better prognosis.

Early diagnosis and management play a big role in treating clubfeet.

Prognosis

Page 14: Congenital Talipes Equinovalrus (Club Foot)

THANK YOU