Download management of neglected club foot

Mr. Zacharia Kimengich
Senior Orthopedic Trauma Technician
Kenyatta National Hospital
Accident & Emergency
BONES OF THE FOOT
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Congenital talipes equino varus (CTEV)for
short is commonly known as clubfoot. This is a
condition where a child presents with either
one or both feet pointing downwards and turns
inwards
It is most common
in male children
compared to
female children.
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The clubfoot is a complex deformity that is rapidly
apparent at birth and in some cases is diagnosed
by prenatal ultrasound. Clubfoot is a major
disabler of children around the world, 150,000200,000 babies with clubfoot are born each year
worldwide. The bones and joints of the foot
deform and child experience complications, due to
lack of awareness or knowledge from parents.
It is the most common congenital problem leading
to locomotor disability. Approximately80% of
children born with a clubfoot deformity are born in
the developing continents like Africa, and the large
Majority of these do not have access to appropriate
medical care. In Kenya the prevalence is 50%.
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Idiopathic Clubfoot
Secondary clubfoot
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Neuropathic clubfoot
Syndromic clubfoot
Postural clubfoot
Metatarsus adductus
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Not a clubfoot
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The exact cause of club foot is not known. An
abnormality of the tendons and ligaments in the foot
causes an abnormal structure and position of the foot.
In some children, bones may also be normal in terms of
shape, size or position. There may be a link to maternal
smoking during pregnancy.
If the foot is abnormally positioned in the uterus
during pregnancy, it may not grow into a normal
shape, but this is not usually considered true club foot
Club foot may in rare instance be associated with
spinal deformities such spinal bifida or other
neuromuscular disease: however, in these cases, the
foot is usually more deformed
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Remained undiagnosed at birth
Treatment unavailable locally
Lack of awareness of available treatment
The treatment given was ineffective
Other reasons: cultural beliefs
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The physical appearance of the clubfoot may
also vary. One or both feet may be affected.
Feet turning inwards
Tightness in the calf muscles
For structural: the foot has decreased joint
range of the movement.
Resting of the foot on its outer border
Rigidity and other changes in the movement of
the foot
“The most common disabling
congenital, orthopaedic condition”.
Clubfoot Incidence:
1:1000 new born
Babies with Clubfeet:
1200 per year
Half of those affected both feet
A lot of children with neglected clubfoot
M>F
Rt > Lt in unilateral cases
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Functional pain-free foot
Plantigrade foot, with good mobility
No need for modified shoes
Most ideal:
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Conservative, early treatment
• (below 2 years of age-Ponseti Method)
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Other Options:
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Surgery
For best outcomes, patients should be
identified and treated early.
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Above knee plaster cast for 5 to 7 days
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Ligaments loosen
Potential Complications
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Pressure ulcers
Skin allergy or irritation
Swelling
Cast slipped
Circulation problems
Rocker bottom foot
Muscle atrophy
Other
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Maintains correction
To be worn for 3 months
full time (23 hrs/day)
To be worn for 2-3 years
at night time only
Failure to wear
appropriately is the most
common cause of
recurrence
- Ministry of Health
- AIC CURE International Children’s Hospital
- Association for the Physically Disabled of Kenya
- Moi Teaching and Referral Hospital
- Kenya Orthopaedic Association
- Kenya Medical Training College
To be continued……..