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Clubfoot Etiology Unknown

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Presentation on theme: "Clubfoot Etiology Unknown"— Presentation transcript:

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

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

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

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

5 Plane of deformity In the hindfoot, coronalrotation produces heel varus (medial) or valgus (lateral) 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

7 Plane of deformity 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 external rotation of the body in the ankle mortise, equinus medial and plantar deviation of the neck of the talus

12 Pathology – bones Calcaneus - Equinus, varus, medial rotation
Navicular, cuboid – medial subluxation Forefoot - adducted and supinated, cavus in severe cases 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 Atrophy of the leg especially in peroneal group, triceps surae, tibialis posterior, FDL,FHL are contracted

15 Pathology - soft tissues
Abnoraml colagen structure Tendon sheaths - o frequently thickened 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) Fascia - contracture of fascial planes and of plantar fascia

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

17 Classification – Dimeglio
soft-soft – postural (20%) 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-stiff – correction of equinus and varus less than 20%, hindfoot varus 45 (12%)

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

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

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

25 Operative treatment Posterior release Posteromedial release
Posteromedial and lateral 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, Foot cavus – osteotomy of cvalcaneus Dwyer and Dwyer II Over 12 years – triple arthrodesis 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 Etiology not completely understood-packing abnormalities (abnormal mechanical intrauterine forces)

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

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

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


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