Clubfoot

synonym

medical: Pes equinovarus

English: stump foot

General

Under a Clubfoot one understands a misalignment of the Foot. A distinction is made between two forms. On the one hand there is innate formwhich occurs more frequently, as well as the acquired formwhich is mostly caused by disorders of the nerve supply and therefore also "Neurogenic clubfoot" is called.

Congenital form

This form is one of the Malalignment of the extremities, it is a combination of various deformities of the Foot. In addition, the sole of the foot shows a Inward rotation (Supination) and the Lower leg muscles Anomalies. The innate form of clubfoot occurs with a Frequency of 1: 1000 with boys being affected twice as often as girls. So the clubfoot is the one second most common congenital malformation after the hip joint malposition (Hip dysplasia). The cause of this congenital malformation is not yet entirely clear. It is believed that the muscles and that connective tissue not train in the right proportion.
This creates one Muscle imbalance, whereby the Changed bone growth and clubfoot could develop. Another attempt to explain it is that the development of the foot stops at an earlier stage and therefore resembles an early embryonic foot. There are several hypotheses for those flawed developments, such as a unfavorable location of the Embryos, one Decrease in the amount of amniotic fluid, as well as the Consequence of taking medication like folic acid antagonists (Methotrexate). This foot deformity can occur on one or both sides, but in half of the cases both feet are affected by the deformity.

Appearance

Congenital limb malalignment is a combination of several deformities. It is a complex and severe malformation of the entire foot and not just a misalignment of the joints. With a clubfoot, there is one Inward rotation (Supination) of the foot being the The sole of the foot points inwards: Pes varus. In addition, the Foot in an equinus position, the foot is pulled in the upper ankle joint towards the sole of the foot: Pes equinus.
That also explains that Synonym "Pes equniovarus". Usually are further misalignment lockable feet: Sickle foot position of the forefoot (Pes adductus) and a Arches foot (Pes excavatus).

Associated with this there is a Shortening the Achilles tendon. This means that without treatment, those affected can only walk on the outer edge of the foot, in particularly severe cases even only on the back of the foot.

Diagnosis

The diagnosis arises based on the clinical picture of the foot. A further notice can a very thin and shortened calf be. In addition, a X-ray image of the foot be created around the The angle between the heel and the distal bone to determine. This angle will too talocal-caneal angle called and is typically less than 30 °. The X-ray image is also required in order to plan the therapy optimally and individually and to be able to document the success of the therapy.

Acquired form

In the acquired form of clubfoot, the weakening of the peroneus longus and brevis muscles leads to this deformity. The tibialis posterior muscle gives the foot its typical shape and is therefore also known as the “clubfoot muscle”.

treatment

The treatment depends on the cause and the severity of the deformity but one early treatment is very important in all cases. Because if the treatment is started early and carried out consistently, that is Good prognosis. The foot position should be controlled until growth is complete become. Without treatment, however, the clubfoot persistswhich can cause pain when walking and standing.

Conservative

As a conservative therapy stands a Clubfoot cast available. The congenital form is usually as soon as possible after the birth started this therapy. There are basically Thigh casts and no lower leg casts applied. This form of therapy will too Redression treatment called. At the beginning, the plaster casts have to be changed daily and the foot position has to be corrected more and more. Later it is sufficient to renew the plaster casts at weekly intervals. Supportive a physiotherapy treatment recommended, because this strengthens and stretches the muscles. Once the misalignment of the foot has been corrected, it is still necessary to keep the foot in this position.
This is usually done through Night splints and additional insoles. It should be as it grows again to the appearance of the deformity can come final correction then through additionally Extension of the tendon of the "clubfoot muscle" respectively. A another conservative option treatment of clubfoot consists of correcting the malformation using insoles or by adapting a so-called Anti-varus shoe. There are also other different ones Orthotics available, which can be individually adapted by an orthopedic technician. Generally, an attempt is made to keep the foot flexed knee with maximum inward edging (the outer edge of the foot is raised and the inner edge is lowered) and lateral splaying to correct.

Operational

The optimal age to surgically treat all structures is around three months. The Achilles tendon is lengthened and the angle between heel and calcaneus is corrected. The aim of the operation is to correct all structures involved, so it may sometimes be necessary to straighten individual ankles.

Read more about the operational process: Tenotomy

forecast

The prognosis of clubfoot deformity is dependent on early treatment. If left untreated, the deformity will definitely persist, and it may even worsen as it grows. The bone grow deformed that Joints slip out of their normal position and the Muscles harden increase. All of this leads to a increasing stiffening of the foot and it comes to Pain when walking and standing.But after the diagnosis is made, it is immediately followed by a adequate therapy started it can become one complete healing come. In addition to a intensive plaster cast treatment but in many cases it is necessary to use the Lengthen the Achilles tendon in one operation.

Summary

The clubfoot is one complex deformity of the foot, at the one acquired and a innate form can be distinguished. The congenital clubfoot is the after the hip joint malposition second most common congenital deformity, with boys being affected twice as often as girls. The various malformations that together form the clubfoot are one Equinus, a Arches foot, one Sickle foot position of the forefoot and a Inward rotation of the foot. Besides, they are Shortening of the Achilles tendon and a Curvature of the calf muscles typical, therefore also called "clubfoot calf". One thing is definitely important early and intensive therapy. Usually with a Redression treatment started, the clubfoot is through Plaster casts corrected gradually. With consistent treatment there is one complete healing possible. Untreated however it comes to Pain when walking and standing.