AFO FOR CLUBFOOT PDF Print E-mail

1. What is clubfoot?

Clubfoot, also known as talipes equinovarus, is a congenital (present at birth) foot deformity. It affects the bones, muscles, tendons, and blood vessels and can affect one or both feet. The foot is usually short and broad in appearance and the heel points downward while the front half of the foot (forefoot) turns inward. The heel cord (Achilles tendon) is tight. The heel can appear narrow and the muscles in the calf are smaller compared to a normal lower leg.

http://img.orthobullets.com/Pediatrics/Foot%20Conditions/Clubfoot/Images/Clinical%20photo%20-%20courtesy%20Miller.png

 

It occurs in about one in every 1,000 live births and affects boys twice as often as girls. Fifty percent of the cases of clubfoot affect both feet.

2. What causes clubfoot?

Clubfoot is caused by a congenital deformity in the development of the muscles, tendons, and bones of the foot. However, why this occurs is unknown. There is some belief that clubfoot can be inherited in some cases.

 

Achilles Tendon action

Achilles Tendon and Related Muscles

3. What are the risk factors for clubfoot?

A risk factor is something that increases your chance of getting a disease or condition.

Because the cause of clubfoot is not understood, not many of the risk factors for this condition are known. However, some of the following factors increase your chance of developing clubfoot:

  • Being male
  • Having a family history of clubfoot

Babies born with clubfoot may also be at increased risk of having an associated hip condition, known as developmental dysplasia of the hip (DDH). DDH is a condition of the hip joint in which the top of the thigh bone (femur) slips in and out of its socket because the socket is too shallow to keep the joint intact.

4. How is clubfoot diagnosed?

Clubfoot is easily diagnosed during a physical examination, but an x-ray of the foot will also be taken. The condition can often even be diagnosed before birth during an ultrasound examination.

Fetal Ultrasound

5. Treatment for clubfoot

The initial treatment of clubfoot, regardless of severity, is nonsurgical. The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. Treatment for the newborn with clubfoot is by manipulation to correct the condition and then casting to maintain the correction. Casting begun at a later age may be more difficult due to the worsening ligamentous contracture and joint deformity. Long-leg plaster casts are used to maintain the corrections obtained through manipulations. Casts are changed at weekly intervals, and most deformities are corrected in two months to three months. Despite successful initial treatment, clubfeet have a natural tendency to recur. Bracing is necessary for several years to prevent relapses.

6. Orthosis

There are several different braces that are commonly prescribed. All braces consist of a bar (the length of which is the distance between the child’s shoulders) with either shoes, sandals, or custom-made orthoses attached at the ends of the bar in about 70 degrees of external rotation. The bar can be either solid (both legs move together) or dynamic (each leg can move independently). Chen et al (2007) found that the dynamic brace has a higher compliance and lower complication rate than the traditional solid brace.The brace is worn 23 hours a day for three months and then at nighttime for three to four years. In children with only one clubfoot, the shoe for the normal foot is fixed on the bar in 40 degrees of external rotation. Bracing is critical in maintaining the correction of the clubfeet. If the brace is not worn as prescribed there is a near 100 percent recurrence rate.

Babies might get fussy for the first few days after receiving a brace, and will require time to adjust. It is important to check the child’s feet several times a day after initiating the bracing to ensure no blisters are developing on the heel.


 

7. Casting

With casting, the foot is manually manipulated by the doctor into a better position and placed in a series of casts. A new cast is put on every week for 5-10 weeks to stretch the soft tissues of the foot and reshape it.

After the initial casting procedure is completed, a brace is used and worn at night and during naps.

8. Surgery

Surgery may be done to correct the deformed tendons and muscles in very severe cases that do not respond to casting.

9. Prevention

There is no known way to prevent clubfoot, as the cause of the congenital deformity is unknown.

 

 

Original Article Reference: http://pediatricorthotics.wordpress.com/professional-resources/
Original Article Reference:  http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/clubfoot