CLUB FOOT Definition:  A clubfoot or congenital talipesequinovarus (CTEV) is a congenital deformity involving one foot or both.

T he affected foot appears rotated I nternally at the ankle. It is classified into 2 groups: Postural TEV or Structural TEV. Without treatment persons afflicted often appear to walk on their anklesor on the sides of their feet. It is a common birth defect occurring in about one in every1 000 live births.  Club Foot is sometimes confused with other congenital foot defects, such as Calcaneovalgus and Metatarsus adductus. These deformities are caused by the position of the foot in the womb and are usually corrected with minimal intervention. True clubfoot affects all the joints, tendons and ligaments in the foot and is often referred to as Congenital TalipesEquinoVarus. Another form of clubfoot is Congenital Vertical Talus, this is not as common as true clubfoot, the foot appears more rigid then a true club foot deformity. In most cases, clubfoot is idiopathic, which means that the cause is unknown and there is no genetic tendency. However it is associated with Spina Bifida and Hip Dysplasia.  Gross deformity of the foot that is giving in the stunted lumpy appearance  Compromised bone strengths  Loss of normal density and quality bone APPEARANCE
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High arched foot that may have a crease across the sole of the foot. The heel is drawn up. The toes are pointed down. The bottom of the foot (heel) is pointed away from the body. Thus, the foot is twisted in towards the other foot (please refer to photograph below)

The above photograph is of a Clubfoot deformity in a child of six months.

The above photograph is of a Clubfoot deformity in a new born child,

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The foot and leg may be smaller in comparison to a comparatively normal child. The foot will lack motion and be noticeably stiff. The calf muscle may also be smaller.

SYMPTOMS
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The foot turns inward and downward at birth, resisting realignment. The calf muscle and the foot may be slightly smaller than normal.If left untreated the child will walk on the outer top surface of the foot. The patient may also experience corns, hard skin and in growing toenails. Clubfoot in adulthood can lead to difficulty in purchasing shoes and a gait abnormality (walking pattern).

PATHOPHYSIOLOGY  In some cases club foot is just the result of the position of the baby while it is developing in the mother womb. But more often club foot is caused by a combination of genetic and environmental factor that is not well understood. Common in boys than in girls. If someone on your family has club foot, then it is more likely to occur in your infant. DIAGNOSTIC EXAM  X-ray  CT scan  Ultrasound scan- done while fetus is on the womb TREATMENT and MANAGEMENT The aim of the treatment regime should be: 1. Correct the deformity early. 2. Correct the deformity fully 3. Hold the correction until growth stops. a. Gentle Manipulation  Passive foot exercises (full range-of-motion) -are executed by the primary caregiver to further maintain the position. b. Immobilization  Casting
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This may be begin from the 1st day of life to several weeks after birth. The foot is pushed and twisted into an over corrected position by the Orthopedist. The cast is then applied in order to hold the foot into that position. This may be uncomfortable for the child. Casts are usually changed every two weeks. Splints or braces may be used after a few years of casting the feet.

 Ponseti Method y The Ponseti method is a complete treatment method that is 97% successful in correcting the clubfoot deformity without major surgery that was common practice. y Treatment will ideally start immediately after birth, it involves serial manipulation of plaster casting of the club foot. A plaster cast is them applied after each weekly session to retain degree of connection obtained and to soften the alignment.

 Kite Method y Used in POC y It is a repeated manipulation and casting. Manipulation was performed with pressure applied over the calcaneocuboid joint and the foot was never beyond neutral.

c. Brace to maintain correction  Dennis Broune Brace y Consist of 2 padded metal foot plates connected b a flat horizontal bar. y Used as a follow up measures to help promote bilateral correction and strengthen the foot muscle. y Used when long leg cast is removed after 3 weeks of treatment. The bar is fit shoulder width apart and worn full time for the 1st 2 monthsafter the last cast is removed  Knee ankle foot orthoses (KAFO) y Is a long leg orthoses that spans the knee, the ankle, and foot in an effot to stabilize the joint and assist the muscle of the leg. Nursing care  Perform exercise as ordered  Child who is learning to walk must be prevented for trying to stand: apply restraints if necessary  Encourage parents to hold and play with child and participate in care to promote bonding  Elevate the extremity to promote venous return and prevents edema.  Check the toes every 1-2 hours for temperature, color, sensation, motion, and capillary refill time.  Stimulate movement of toes to promote circulation.  Provide comfort measures such as soft music, pacifier, teething ring, or rockingto promote relaxation and may enhance patients coping abilities by refocusing attention.  Discuss the importance of physical therapist to enhance mobility