Clubfoot is an anomaly of the development of the musculoskeletal system, characterized by a deviation of the fingers inside, bending the inner edge of the sole up and inside. It is manifested by external deformation, change in gait, restriction of foot movements. Possible pain. Diagnosis of clubfoot in children under 3 months is carried out by ultrasound, in older children – by X-ray examination. Treatment is carried out by an orthopedist and includes wearing orthopedic shoes, massage, gymnastics, physiotherapy, it is possible to use plaster bandages and special tires.
Q66.8 Other congenital deformities of the foot
Clubfoot (equinovarus deformity of the foot) is one of the most common abnormalities of the musculoskeletal system (33-38%). As a rule, it occurs from two sides. In boys, clubfoot is detected twice as often as in girls.
What causes clubfoot
The causes of the pathology are not completely clear. It is assumed that the risk factors for clubfoot may be anomalies of fetal position, lack of amniotic fluid, smoking, alcohol and narcotic drugs. Due to the adverse effect on the fetus, the development of the bones of the foot, muscles and nerves of the lower leg is disrupted. Secondary clubfoot is possible, resulting from the pathology of other parts of the musculoskeletal system.
In traumatology and orthopedics , the following types of clubfoot are distinguished:
- Idiopathic clubfoot. It is characterized by a decrease in the talus bone, combined with a pathological location of its neck, equinus (equine foot), in which the heel is pulled up and the foot is bent towards the sole, a violation of the location of the front part of the foot relative to the back, a violation of the development of the articular surfaces of the joints of the foot, shortening of the calf muscle, a violation of the development of tibial vessels in the anterior parts of the lower leg.
- Postural clubfoot. The calcaneal and talus bones are not changed. Articular surfaces are normally developed and are in a state of subluxation.
- Congenital clubfoot, combined with congenital neuropathy and myopathy. The deformity of the foot is secondary in nature, caused by the pathology of the development of other parts of the musculoskeletal system (multiple curvature of the bones of the extremities, bilateral congenital dislocation of the hip, etc.).
- Syndromological clubfoot. The combination of the previous form of clubfoot with extra-skeletal pathology (amniotic constrictions, anomalies of kidney development, etc.).
There is equinus, varus deformation (the foot is bent, the fingers are deflected inwards) and supination (the foot is deployed with the sole up and inwards). Movements in the ankle joint are limited. Due to the change in the position of the foot, a child with clubfoot does not rely on the entire sole when walking, but on the outer edge of the foot. A peculiar gait develops, in which the patient steps over the supporting leg during each step.
Over time, the violations get worse. The bones of the foot are deformed even more, there are subluxations in the joints of the foot. The skin of the outer surface of the feet becomes rough. The muscles of the shins that are not involved in walking atrophy, the work of the knee joints is disrupted. The later the treatment of congenital clubfoot is started, the more difficult it is to compensate for the resulting disorders and restore the shape of the foot.
It is important to determine whether clubfoot is true (due to a violation of the development of the bones of the foot) or positional. With positional clubfoot, the patient’s foot is more mobile, actively or passively removed to the normal position. Equinus is weakly expressed. There are transverse folds on the back of the foot, indicating sufficient mobility. As a rule, positional clubfoot disappears independently during the first weeks of a child’s life, however, when this form of clubfoot is detected, conservative therapy is indicated in any case.
X-ray or CT methods are uninformative when examining children under 3 months, since at this age bones consist mainly of cartilage tissue and are not displayed on radiographs. Children older than three months are X-rayed in two projections: anterior-posterior and lateral. Radiographs are made with the maximum possible plantar and dorsal flexion of the foot. Ultrasound is used to examine children under 3 months of age. This method is absolutely harmless, but less informative, because it allows you to see only one of two levels (side view or top view).
The treatment tactics are chosen by an orthopedic traumatologist depending on the severity of the pathology. Treatment should be as early, consistent and permanent as possible. The outcome of treatment depends on the degree of clubfoot. With a slight degree of clubfoot, in 90% of cases it is possible to correct the position of the foot without surgery. Severe clubfoot is corrected conservatively in only 10% of cases.
Conservative therapy of clubfoot begins from the first weeks of the patient’s life, because during this period the bone structures of the child’s foot are very soft and the foot can be moved to the correct position without surgery. Therapeutic gymnastics and foot massage are prescribed. Soft fixation of the feet with flannel bandages is used. After correcting the shape of the foot, a special splint is applied to the child’s leg. With a more pronounced clubfoot, a step-by-step removal of the foot to the correct position is carried out using plaster bandages.
Subsequently, children with clubfoot are shown physiotherapy, massage, therapeutic gymnastics, wearing orthopedic shoes. At night, special polyethylene tires are applied to the legs. If conservative correction of clubfoot is ineffective, an operation is performed. Surgical treatment is carried out when the child reaches the age of 1-2 years, includes plastic surgery of tendons, ligamentous apparatus and aponeurosis of the foot. In the postoperative period, the wearing of plaster bandages is prescribed for up to six months.
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