Posted by: Indonesian Children | August 15, 2009

Club Feet in Children

 

Club foot is the second most frequent paediatric foot condition. It affects 2 per 1000 live births and could be bilateral in 25% of cases. Males are more frequently affected than females by 2:1.

The deformities in club foot are complex and involves the whole foot, ankle and leg. In the hind foot the ankle joint is flexed (equinus deformity) and the heel is turned in (varus deformity). In the forefoot there is a high medial arch (cavus deformity) and the foot has a bean shaped and curled outer border (forefoot adductus deformity). The whole leg, foot including calf muscles are smaller on the affected side.

In 30% of cases this deformity is flexible and rapidly resolves after birth. In the remaining 70% the deformity is stiff and if left untreated it would lead to severe painful deformities in the long-term and the affected child could end up walking on the outer aspect of the foot.

Most cases of club foot are idiopathic (unknown cause) in nature and the child is otherwise entirely normal. In minority of cases (<5%) this deformity is secondary to other conditions such as neuromuscular disease or syndromes. There is also an increased risk of developmental dysplasia of the hip (DDH) in children with club foot and screening for this condition is therefore mandatory.

Clubfoot is a congenital foot condition, which affects approximately 1 out of every 1000 births . However, prevalence of this condition is twice as more in males then females. The deformity can be mild or severe and it can affect one foot or both feet. True clubfoot affects all the joints, tendons and ligaments in the foot and is often referred to as  

Congenital Talipes EquinoVarus.

Appearance

  • High arched foot that may have a crease across the sole of the foot.
  • The heel is drawn up.
  • The toes are pointed down.
  • The bottom of the foot (heel) is pointed away from the body. Thus, the foot is twisted in towards the other foot

 


Treatment

There are many treatments available for clubfoot and many different opinions exist concerning treatment regimes. The two main forms of treatment are casting and surgery. Rapid resolution of the deformity is generally expected within weeks and it is unlikely other methods of treatment would be necessary.

For rigid or inflexible deformities my preference is to use Ponseti’s method of treatment. This is currently gathering increasing popularity and recent comparative studies have shown results equivalent or even superior to traditional methods of treatment such as surgical soft tissue releases.

Ponseti Treatment in my experience this is best suited for infants and young babies (< 6 months age).

Treatment starts initially by stretching the deformity to its maximal position of correction and applying an above knee cast using plaster of Paris. This is repeated on a weekly basis for 6 weeks and a new cast is applied on each occasion.

In 20% of the cases complete correction of the deformities is observed within this 6 week period of stretching and casting. However, in 80% of cases the hind foot equinus deformity may persist. In these cases the complete correction of the deformity is achieved at week 7 by performing a small operation to release the tendo-Achilles (percutaneous tendo-Achilles release).

When complete correction of the deformities has been achieved an above knee cast is applied for another 6 weeks. At 12 weeks following start of treatment, all casting is discontinued.

To avoid recurrence of deformity use of a Denis Browne splint at night time is recommended until age 2 years. Note splinting is not required during day time.

The success rate of Ponseti treatment is about 85-90%. For failed cases or children with severe recurrent deformity, surgery may be required at a later date. In general the procedures necessary to treat failed Ponseti cases are lesser in magnitude as compared with traditional operative procedures for correction of club foot deformity. Most cases with recurrent deformity after Ponseti treatment need a simple tendon transfer at the age 3-4 years (tibialis anterior tendon transfer).

Prognosis With appropriate treatment we expect most children (>95%) with clubfoot deformity to lead a normal life into adult hood and even take part in strenuous physical activities.

 

Supported  by
CLINICAL PEDIATRIC ONLINE 

Yudhasmara Foundation 

JL Taman Bendungan Asahan 5 Jakarta Indonesia

phone : 62(021) 70081995 – 5703646 

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/ 

 

 

Clinical and Editor in Chief :

WIDODO JUDARWANTO 

email : judarwanto@gmail.com,

 

Copyright © 2009, Clinical Pediatric Food Allergy Information Education Network. All rights reserved.


 

Deformities in Club Foot


Thin Calf Muscles & Smaller Foot


 

Ponseti Treatment
Stretching & Application of Serial Corrective Casts



 




 

Denis Browne Splint

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