CLUBFOOT OR CTEV (congenital talipes equinovarus ) and splint

CLUBFOOT OR CTEV (congenital talipes equinovarus ) and splint:-

 

Clubfoot is a congenital contucture of the joint of the foot.The main clinical sign of  congenital talipus equinovarus are:

– Equinus (plantar flexion of the foot in the ankle joint)

– Supination (the plantar surface of the foot is turned inward)

– Forefoot adduction (the anterior part of the foot is displaced medially)



Congenital clubfoot presents in two clinical forms,namely Typical (75 percent) and Atypical (25 percent).

In addition to the deformity of the foot children with congenital clubfoot have a leg rotated inward and restricted movement of the ankle joint.The degree of deformity is a aggravated as soon as the child begins to walk,and skin on the outer border of the foot becomes rough,and callosities develop with bursae.

-CAUSES:-

1)-Mechanical theory-due to abnormal intraterine position of the fetus.

2)-Ischaemic theroy-ischaemia of calf muscles during intrauterine life resilts in contracture,leading to foot deformities.

3)-Genetic theory-some genetically related disturbances in the development of  foot leads to deformity.

4)-Neuromuscular deficit.

-Methods of maintenance of the correction:

a)-CTEV splints:-These are splints made of plastic,molded in such a way that when tied with straps,it keeps the foot in ercorrected position

.

b)-Denis-brown splint (db) splint:- This is a splint to hold the foot in the corrected position.It is used throughout the day before the child starts walking.Once he starts walking,a DB splint is used at night and CTEV shoes during the day.

c)- CTEV shoes:-These are modified shoes used once a child starts walking.The following modification are made in the shoes:

-Straight inner border to prevent forefoot adduction.

-Outer shoes raise to prevent foot inversion.

-No heel to prevent equinus.

This shoes are used until the child is 5 years old.
OPERATIVE METHODS :-

STR alone may be sufficient in younger children [ younger than 3 ] ,bony operations may be required in older children.
The following operations r performed:
1.POSTERIOR –MEDIAL SOFT TISSUE RELEASE [PMSTR]

The following structures are released :

On the posterior side – lenthening of tendo achilles by Z –plasty .Release of posterior capsules of the ankle and subtalar joints.Release of posterior talo fibular and calcaneo fibular ligaments .

– On The Medial Side : lengthening of 3 tendons i.e. TP , FDL , FHL.

-Release of 3 ligaments i.e. talo navicular lig, deltoid lig, spring lig.

-Release of 3 structures is needed in severe cases.

PHYSIOTHERAPY MANAGEMENT:-

§EQUINO VARUS: When  reported early , most of the children can be managed by  PASSIVE MANIPULATION.

It should be followed by IMMOBILISATION either by strapping , if the deformity is minimal ,or by POP cast.

MANIPULATION :The 3 components of the deformity are –

1.Pes cavus

2.Adduction and inversion of the forefoot and heel .

3.Plantar flexion of the ankle.

Manipulation by passive movement is done in the direction opposite to the deformity.

The pes cavus deformity is corrected first .The contracted soft tissues at the sole of the foot are stretched gradually till total correction is achieved.

§Secondly ,the adduction deformity is corrected by keeping thumbs of both the hands over the talus ,the talus thus becomes the fulcrum of the movement.

The fingers of the distal hand hold the foot and those of the proximal grasp the lower  portion of the leg and medial aspect of the heel .

The distal hand will abduct and evert the foot ,turning the sole downwards and outwards.[eversion and dorsiflexion].

§Thirdly ,by shifting the distal hand along the length of the sole ,the foot is raised to dorsiflexion thus correcting the component of plantarflexion.

The mother should be educated to identify if any distortion occurs.

In mild cases immobilisation can be done by a strip of adhesive plaster.this can be continued for 2 months.

CLUBFOOT OR CTEV (congenital talipes equinovarus ) and splint

CLUBFOOT OR CTEV (congenital talipes equinovarus ) and splint