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Manuain 11-2012-175
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.
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.
Mild clubfoot must be distinguished from positional equinovarus. Teratologic type of severe clubfoot deformity usually associated with spina bifida.
Dennis Brown type boot splint or articulated AFO to be worn day and night (3 months).
Outflare boots are used for day wear until the child is 3 years of age.
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.
Operative treatment is a meticulous soft tissue correction of all tendon and joint contractures at 4 to 6 months.
Continuation leads to failure, because of persistent incomplete correction or recurrence of deformity. Immobilization pressure necrosis in joint cartilage.
Principal: Complete release of the joint (capsular and ligamentous contractures and fibrotic bands). Lengthening of the tendons so the foot can be positioned normally.
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.
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.