1. MANAGEMENT OF NEGLECTED CLUB FOOT
Mr. Zacharia Kimengich
Senior Orthopedic Trauma Technician
Kenyatta National Hospital
Accident & Emergency

2. BONES OF THE FOOT

3. WHAT IS CONGENITAL TALIPES EQUINOS VARUS(CTEV)
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.

4. 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, ,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%.

5. Classification based on Causes
Idiopathic Clubfoot
Secondary clubfoot
Neuropathic clubfoot
Syndromic clubfoot
Postural clubfoot
Metatarsus adductus
Not a clubfoot

6. CAUSES OF CLUBFOOT
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

7. Why are there so many children with untreated or uncorrected clubfeet ?
Remained undiagnosed at birth
Treatment unavailable locally
Lack of awareness of available treatment
The treatment given was ineffective
Other reasons: cultural beliefs

8. SIGNS AND SYMPTONS
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

9. The Clubfoot Burden in Kenya
“The most common disabling congenital, orthopaedic condition”.
Clubfoot Incidence: 1:1000 new born
Babies with Clubfeet: per year
Half of those affected both feet
A lot of children with neglected clubfoot
M > F
Rt > Lt in unilateral cases

10. Clubfoot Treatment Options
Goal of Treatment
Functional pain-free foot
Plantigrade foot, with good mobility
No need for modified shoes
Clubfoot Treatment Options
Most ideal:
Conservative, early treatment
(below 2 years of age-Ponseti Method)
Other Options:
Surgery
For best outcomes, patients should be identified and treated early.

11. The Ponseti Method: casting
Above knee plaster cast for 5 to 7 days
Ligaments loosen

13. Potential Complications
Pressure ulcers
Skin allergy or irritation
Swelling
Cast slipped
Circulation problems
Rocker bottom foot
Muscle atrophy
Other

14. The Foot Abduction Brace (FAB)
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

15. Local Partnerships - Ministry of Health To be continued……..
- 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……..