is a condition of adduction of the fore footfoot, inversion(varus) of the foot, and downward pointing of the foot and toes

(equinus)

 It is a common birth defect, occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. In most cases it is an isolated dysmelia. This occurs in males more often than in females by a ratio of 2:1

 Clubfoot is usually noticed by the doctor at birth. The foot is turning inwards at the ankle and points down. The achilles tendon is tight. The front half of the foot is turned inward, giving the foot a kidney bean shape. If not corrected in infancy or if missed (not likely), the infant will walk on the outside of the foot and not be able to get the bottom of the foot flat on the ground. There maybe a decrease in size of the calf muscles and the affected foot may be smaller than the unaffected side.

Equinus (plantarflexion) Calcaneus (Dorsiflexion) Varus (foot turns inward) Valgus (foot turns outward)

 Prenatal diagnosis
Most of the time, a baby s clubfoot is diagnosed prenatally (before birth) with ultrasound.* About 10 percent of clubfeet can be diagnosed as early as 13 weeks into pregnancy. By 24 weeks, about 80 percent of clubfeet can be diagnosed, and this number steadily increases until birth.

Diagnosis after birth

Exams and tests that may help confirm a diagnosis of club foot include:

Physical Exam, including a complete family history Result: Twisted foot appearance should be assessed and gently manipulated. If the straightened foot does not move to a normal position, true clubfoot is present.

 Radiography
X-rays confirm the diagnosis and provide precise information about the placement of the foot and ankle bones. Result: Use of x-rays is definitive diagnosis for clubfoot as it determines abnormal bone anatomy and assesses the treatment efficiency.

 New Born Screening Diagnosis is usually made when the baby is examined immediately after birth, at which time a clubfoot is easily recognized on the basis of its appearance Result: adduction - or inward turning - of the metatarsals, varus - or inversion of the hindfoot, equinus - or plantarflexion - of the ankle, and cavus - or high arch - of the forefoot.

pushes and twist the foot into an over connected position and then cast is applied to ensure holding of foot in same manner Applies certain techniques to reduce and correct the deformity to promote normal foot mobility and position. Methods used are the following:

 Manipulation - Slightly pivoting the bones and stretching the soft tissue

 Placement of above the knee cast

Frequency of changing the cast is every 5-7 days to accommodate the rapid growth during the first year of life. In most cases, severing of Achilles tendon (tenotomy) is done before the final cast is applied. The reason for doing this is to loosen the foot. The procedure is usually done in a clinic where a local anesthetic is used. A small cut (about 3 mm) is made above the heel of the foot to lengthen the tendon. After the procedure final casting is done. Final cast is removed after 2-3 weeks when Achilles tendon is already healed.

 After the final cast is removed:

(shoes or boots attached to a bar) are used 23 hours each day for 3 months to maintain the normal foot alignment. For the next 2-4 years the splint is fitted during naps and night time only. 2. Passive foot exercises (full range-of-motion) are executed by the primary caregiver to further maintain the position.

Method used for complex ankle-foot deformity. Ilizarov frames, the circular structure placed around the limb, are used in this technique which are attached to metal pins and are inserted through the bone. A frame is individually made for each patient and weighs approximately 7 lbs. Placement of the frame requires the administration of a general anaesthetic and the procedure may last for several hours.

 This method consists of daily physical therapy, featuring gentle and painless stretching of the foot. The foot is then taped to maintain the corrected position until just the next day's visit. At night, the taped foot is inserted into a continuous passive motion machine at home to maximize the amount of stretching. The tape is removed for a few hours each day to wash the foot, air the skin, and to perform exercises. Removable splints are also used to support the taped foot. The one-hour physical therapy sessions are conducted five days each week for approximately three months. Taping is stopped when the child starts walking.

 Surgery is indicated if non-operative treatment has not been successful. Surgery may be needed to adjust the tendons, ligaments and joints in the foot/ankle. Usually done at 9 to12 months of age, surgery corrects all of your baby's clubfoot deformities at the same time.

Posteromedial Release
The last option for a clubfoot is the release of all tight tendons and ligaments in the posterior and medial parts of the foot. The structures are then put back together in a lengthened position.

PROCEDURE one-stage soft-tissue posteromedial release; - as a prerequisite, the forefoot adductus deformity should be passively correctable to neutral, in order to avoid wound healing problem - posterior, medial, and subtalar soft-tissue contractures are released to permit the realignment of the abnormal anatomy of the bones, and corrected alignment is secured with a single Kirschner wire, which transfixes the talonavicular joint; -the aim of the procedure is to excise or release all of the pathologically contracted soft tissues that prevent correction of deformity;