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Clubfoot deformation of the shape of the foot and impairment of function.

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Presentation on theme: "Clubfoot deformation of the shape of the foot and impairment of function."— Presentation transcript:

1 Clubfoot deformation of the shape of the foot and impairment of function

2 Clubfoot Etiology Unknown Unknown Most likely a combination of genetic and environmental factors Most likely a combination of genetic and environmental factors

3 Incidence 0,4-1:1000 live births 0,4-1:1000 live births Male : Female 2:1 Male : Female 2:1 50% Bilateral 50% Bilateral

4 Location of deformity Forefoot-phalanges and metatarsal Forefoot-phalanges and metatarsal Midfoot-cuboid navicular cuneiforms Midfoot-cuboid navicular cuneiforms Hindfoot-talus calcaneus Hindfoot-talus calcaneus

5 Plane of deformity In the hindfoot, coronalrotation produces heel varus (medial) or valgus (lateral) In the hindfoot, coronalrotation produces heel varus (medial) or valgus (lateral) Sagital plane rotation of the the hindfoot produced equinus (plantarflexion) or calcaneus (dorsiflexion) Sagital plane rotation of the the hindfoot produced equinus (plantarflexion) or calcaneus (dorsiflexion)

6 Plane of deformity Coronal rotation of the midfoot and forefoot is discribed as adduction or abduction as it relates to medial or laterl deviation of the foot Coronal rotation of the midfoot and forefoot is discribed as adduction or abduction as it relates to medial or laterl deviation of the foot

7 Plane of deformity Pronation and supination are axial rotations through the midfoot and the midfoot-forefoot articulation Pronation and supination are axial rotations through the midfoot and the midfoot-forefoot articulation

8 Equinus deformity

9 Supination & heel varus

10 Forefoot adduction

11 Pathology – bones Talus abnormal relationships including: anterior extrusion of the body of the talus anterior extrusion of the body of the talus external rotation of the body in the ankle mortise, equinus external rotation of the body in the ankle mortise, equinus medial and plantar deviation of the neck of the talus medial and plantar deviation of the neck of the talus

12 Pathology – bones Calcaneus - Equinus, varus, medial rotation Calcaneus - Equinus, varus, medial rotation Navicular, cuboid – medial subluxation Navicular, cuboid – medial subluxation Forefoot - adducted and supinated, cavus in severe cases Forefoot - adducted and supinated, cavus in severe cases Femur, tibia and fibula - the entire lower limb can be shorter Femur, tibia and fibula - the entire lower limb can be shorter

13 Pathology – bones

14 Pathology – muscles Imbalance of type I and II, fibrosis caused by infiltration of fibroblast Imbalance of type I and II, fibrosis caused by infiltration of fibroblast Atrophy of the leg especially in peroneal group, triceps surae, tibialis posterior, FDL,FHL are contracted Atrophy of the leg especially in peroneal group, triceps surae, tibialis posterior, FDL,FHL are contracted

15 Pathology - soft tissues Abnoraml colagen structure Abnoraml colagen structure Tendon sheaths - o frequently thickened Tendon sheaths - o frequently thickened Joint capsules – severe cases: contractures of ankle, subtalar, talonavicular, calcaneocuboid Joint capsules – severe cases: contractures of ankle, subtalar, talonavicular, calcaneocuboid Ligaments - severe cases: contractures of calcaneofibular + talofibular ligs, deltoid lig, long and short plantar ligs, spring lig, long plantar lig. (bifurcate lig) Ligaments - severe cases: contractures of calcaneofibular + talofibular ligs, deltoid lig, long and short plantar ligs, spring lig, long plantar lig. (bifurcate lig) Fascia - contracture of fascial planes and of plantar fascia Fascia - contracture of fascial planes and of plantar fascia

16 Classification Postural - postural or positional talipes can be passively fully corrected or even overcorrected Postural - postural or positional talipes can be passively fully corrected or even overcorrected Fixed Fixed 1. Flexible 2. Resistant

17 Classification – Dimeglio soft-soft – postural (20%) soft-soft – postural (20%) soft-stiff – correction in saggital and horizontal planes over 50%, hindfoot varus 20  (33%) soft-stiff – correction in saggital and horizontal planes over 50%, hindfoot varus 20  (33%) stiff-soft - correction in saggital and horizontal planes below 50% (35%) stiff-soft - correction in saggital and horizontal planes below 50% (35%) stiff-stiff – correction of equinus and varus less than 20%, hindfoot varus 45  (12%) stiff-stiff – correction of equinus and varus less than 20%, hindfoot varus 45  (12%)

18 Treatment Treatment and outcomes depends on degree of deformation Treatment and outcomes depends on degree of deformation Non-operative Non-operative Operative Operative

19 Non-operative Series of redression casts applied as early as first 7-10 of life Series of redression casts applied as early as first 7-10 of life Casts changed every 7-14 days Casts changed every 7-14 days Post treatment options: lower leg splinters, Dennis-Brown orthosis, footwear, physiotherapy Post treatment options: lower leg splinters, Dennis-Brown orthosis, footwear, physiotherapy Ponseti method – Achilles tenotomy Ponseti method – Achilles tenotomy After 6-12 weeks x-ray control After 6-12 weeks x-ray control

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24 Operative treatment Time of surgery – 6-12 months Time of surgery – 6-12 months Type IV – no conservative treatment Type IV – no conservative treatment Restoration of correct position of bones Restoration of correct position of bones

25 Operative treatment Posterior release Posterior release Posteromedial release Posteromedial release Posteromedial and lateral release Posteromedial and lateral release Complete peritalar release Complete peritalar release

26 Residual deformities Forfoot adductus – opening wedge osteotomy of cuboid, closing wedge osteotomy of calcaneus, partial resection of calcaneus Lichtblau, calcaneo-cuboid arthrodesis Evans, Forfoot adductus – opening wedge osteotomy of cuboid, closing wedge osteotomy of calcaneus, partial resection of calcaneus Lichtblau, calcaneo-cuboid arthrodesis Evans, Foot cavus – osteotomy of cvalcaneus Dwyer and Dwyer II Foot cavus – osteotomy of cvalcaneus Dwyer and Dwyer II Over 12 years – triple arthrodesis Over 12 years – triple arthrodesis Ilizarov method – secondary correction Ilizarov method – secondary correction

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29 Metatarsus adductus MA is medial deviation of the forefoot at the level of the midtarsal joints MA is medial deviation of the forefoot at the level of the midtarsal joints Etiology not completely understood-packing abnormalities (abnormal mechanical intrauterine forces) Etiology not completely understood-packing abnormalities (abnormal mechanical intrauterine forces)

30 Metatarsus adductus treatment Spontaneus resolution-only observation Spontaneus resolution-only observation Home stretching program Home stretching program Serial casts Serial casts Surgery Surgery

31 CONGENITAL FLATFOOT (Planovalgus) Deformity consisting: Deformity consisting: Hindfoot valgus Hindfoot valgus Midfoot supination and abduction Midfoot supination and abduction Deviation of plantar arch Deviation of plantar arch Treatment- surgery Treatment- surgery

32 Calcaneovalgus foot The foot is in extreme dorsiflexion The foot is in extreme dorsiflexion Treatment: Treatment: Home stretching program Home stretching program Serial casts Serial casts Surgery Surgery


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