clubfoot

Clubfoot is a condition in which the foot is deformed and turns inward or outward. The foot deviates from the longitudinal axis that runs along the shin. Clubfoot can be acquired or congenital. People suffering from clubfoot are not alone. Many famous people suffered from this strange disease. Among them were the famous Roman emperor Claudius, the Egyptian pharaoh Tutankhamun, the world-famous Tamerlane, who was called the great lame man. What are the causes of clubfoot and how is it treated, if at all?

What is clubfoot?

Clubfoot, which is classified as congenital, occurs due to certain diseases: skeletal dysplasia, namely dysostosis, arthrogryposis, osteochondrodysplasia. Clubfoot can also be caused by such defects and malformations of the supporting apparatus as unilateral or bilateral longitudinal ectromelia.

Doctors diagnose clubfoot as an independent disease separate from others. The largest percentage of clubfoot is congenital, with other deformities of the legs or arms. Clubfoot can progress if no measures are taken.

If the clubfoot is clearly visible, then the foot turns inward. And the outer edge of the foot is turned backwards and downwards. The inner edge of the foot turns upwards. The back of the foot turns downwards and forwards. The plantar part of the foot turns upwards and backwards. As for the supination of the foot, it is disturbed so much that the heel sometimes touches the inner part of the shin.

Clubfoot is also characterized by twisting of the shin bones outward (called torsion), or by bending of the sole across (called inflection). At the same time, a transverse groove forms in the very middle of the inner part of the foot, it is called Adams' groove.

Clubfoot can also be accompanied by bumps or bones on the feet - they are called hallux valgus. Doctors distinguish degrees of clubfoot: mild, moderate and severe. With mild clubfoot, ankle movements are preserved, so the foot deformation can be easily corrected. With moderate clubfoot, foot movements are no longer so easy, and their correction is required; the disease can be fought, but only partially. With severe clubfoot, surgery is needed - manual methods will not help.

When a person is diagnosed with clubfoot, not only the shape of the foot is impaired, but its functions are also limited. Especially the function of movement, and not only of the foot, but of the entire leg.

Acquired clubfoot

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ICD-10 code

M21.S. Acquired cog-shaped hand, club hand, hollow foot (with high arch) and crooked foot (clubfoot).

Acquired clubfoot develops much less frequently than congenital clubfoot.

What causes acquired clubfoot?

The causes of clubfoot may be damage to the bones of the foot and distal metaepiphysis of the shin bones, burns, acute and chronic inflammatory processes, flaccid and spastic paralysis, etc. Therefore, it is necessary not only to determine the type of deformation, but also to clarify the anamnesis and carefully study the nature of the disease preceding the deformation.

How is acquired clubfoot treated?

The choice of treatment tactics in each specific case is individual. In case of acquired clubfoot, one should not count on the success of treatment using staged plaster bandages and redressing.

In paralytic clubfoot due to damage to the peroneal nerve and muscles or poliomyelitis, the deformity is corrected by restoring the tendons and damaged nerve or by transplanting the tendon of the anterior or posterior tibialis muscle to the outer surface of the foot. Arthrodesis is possible. In older children, subtalar and calcaneal-tuberous arthrodesis give favorable results.

In case of cicatricial post-burn deformations, there is a need for excision of scars, restoration of tendons and skin autografting.

Post-traumatic and post-osteomyelitic deformities can be eliminated by corrective osteotomies with bone plastic surgeries, often using individual designs of the Ilizarov apparatus.

Causes of clubfoot

There are different causes of clubfoot depending on the medical classification. Clubfoot can be caused by genetic factors such as Edwards syndrome, a genetic defect involving chromosome 18. Girls are three times more likely to suffer from this defect than boys. Those at risk are children born to older mothers over 45 years of age.

The genetic influence on foot defects will increase with each subsequent case of the birth of a child with clubfoot. Previously, it was assumed that clubfoot can be caused by external influences on the mother's body at the end of the last trimester of pregnancy. At the same time, the duration of pregnancy can be longer than normal in many cases.

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Theories of clubfoot

There are several theories about what causes clubfoot. It may be hereditary or may be caused by a defect in the egg when a child is conceived. Clubfoot sometimes occurs as a result of paralysis. In its mild form, clubfoot causes minor changes in the structure of the foot; in more severe cases, orthopedic treatments must be used. Although clubfoot is usually congenital, sometimes in an older child, clubfoot can be caused by trauma or polio.

Treatment – consequences and prospects

General treatment is often not enough to correct a child's clubfoot. Surgery may be necessary to correct the structure of the tendons, ligaments, and joints of the foot and ankle. Typically, before the child is 9 or 12 months old, surgery usually corrects the clubfoot.

It is good for the muscles of the baby's foot to try to return the foot to its proper position in clubfoot, and special shoes or braces are usually used for walking for a year or more after surgery. Surgery is likely to result in more leg stiffness than non-surgical treatment, especially over time.

If clubfoot is not treated

Without any treatment, childhood clubfoot can cause serious changes, even disability, but with treatment, the child may have almost normal feet. The child will be able to run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, but clubfoot usually makes the foot a couple of sizes smaller and somewhat less mobile than a normal foot. The calf muscles of the clubfooted leg also become smaller.

Long-term studies suggest that in some cases of clubfoot, additional surgeries may be required. Although there is medical controversy about the effectiveness of such surgeries, in light of the prevalence of recurrence after previous surgeries.

Famous People with Clubfoot

1. Famous Civil War politician Thaddeus Stevens
2. Comedian Damon Wayans
3. footballers Steven Gerrard and Miguel Riffo
4. Famous hockey player Matt Lloyd
5. Mathematician and Nobel laureate Perelman
6. Mathematician Ben Greenberg
7. Directed by Jennifer Lynch
8. British Romantic poets George Gordon, Lord Byron
9. Comedian, musician, actor Dudley Moore

Nazi propaganda minister Joseph Goebbels was born with a foot deformity, having had a botched operation to remove a bacterial infection after osteomyelitis, which doctors mistook for clubfoot. He walked with a shortened leg.

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Peculiarities

Without treatment, clubfoot sufferers are often unable to walk due to the deformity of the ankle, one or both at once. This is a congenital defect that affects approximately one in every 1,000 people born with this defect. In approximately 50% of cases, clubfoot is bilateral. In most cases, it is not an isolated disease. It occurs more often in men than in women in a ratio of 2:1. Clubfoot also appears in animals, especially in horses.

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Treatment of clubfoot

Clubfoot is treated with the help of pediatric manipulations; the services of a physiotherapist, orthopedic surgeon, and traumatologist are also needed.

Sometimes braces are needed to keep the legs in the correct positions. It may also be necessary to use plaster or splints that are applied to the knees, ankles of the legs. Other orthopedic options also include conservative methods, which traumatologists in our country are most inclined to.

Step-by-step plastering

First, the doctor massages the foot using manual manipulation. But forceful techniques are contraindicated: gentle manipulations are needed, without forceful techniques. As soon as the foot is slightly corrected, its position is gradually corrected, a plaster boot is applied to the foot. It is placed on the leg slightly above the foot and above the knee. When a certain time has passed, doctors remove the boot and begin working with the foot again, correcting its position further. Then - again a plaster boot, and so on for several more stages.

This treatment is used in the first year of life of a boy or girl and continues for a year. As a rule, the foot returns to normal. Then the child needs orthopedic shoes so that the foot does not return to the wrong position again. Otherwise, the child's foot will grow and in uncomfortable shoes it risks growing into an incorrect shape.

Foot recovery times

At different stages of treatment and in different medical institutions, treatment periods are different. Orthopedists who adhere to conservative treatment methods may insist on plastering the foot from time to time until the age of 14-15. But sometimes surgical treatment is used. Then it can take up to six months to restore the foot. However, the operation should be performed at an early age - from three months to six months.

Tendon plastic surgery according to Zatsepin can also be used. Then the leg is put in plaster for 3 months, and this plaster is applied above the knee. After removing the bandage, a rehabilitation course is carried out. Then plaster - again for 3 months and another rehabilitation course.

Of course, the recovery time is different in each case, but in most cases, extensive surgery is not required to treat clubfoot. Extensive surgeries can lead to scar tissue developing inside the child's leg. Scars can lead to functional growth and aesthetic problems of the leg, because the scar tissue will interfere with normal movement. A child who has undergone extensive surgeries, on average, undergoes two additional surgeries to correct the problems presented above.

Treatment of clubfoot without surgery

Treatment of clubfoot must begin almost immediately after it is diagnosed to have a chance of a successful outcome without surgery. Over the past 10-15 years, great strides have been made in correcting clubfoot without surgery.

Functional physical therapy, which involves stretching the tendons and muscles of the foot and moving it into the correct position, has been used frequently over the past decade. Compared to patients who have undergone surgery, non-surgical foot manipulations are more effective. The results of these studies have been presented at national and international conferences, such as the Pediatric Orthopaedic Society of North America International Clubfoot Symposium.

Staples

After the correction of the results, the maintenance correction of the foot may require full-time work (24 hours a day). Good results are obtained by using a splint and braces on both feet, regardless of the localization of the clubfoot - where it is - on one side or on both, for several weeks after treatment.

Part of the time is spent wearing braces (usually at night for 12 hours) - for up to 4 years. Without ongoing correction of the foot, the clubfoot will almost certainly recur because the muscles around the foot can pull it back into the wrong position.

Approximately 20% of children may require surgical correction of the foot tendon after two years of manual manipulation. This requires general anesthesia and a minor surgical procedure, avoiding the joints of the legs.

Botox

Botox is also used as an alternative to surgery. Botox is the name for botulinum toxin type A, a chemical that affects the nerves in the leg that control the muscles. This causes the muscles to weaken by preventing muscle contractions. As part of the treatment for clubfoot, Botox is injected into the calf muscle of children. Over a period of about a week, Botox weakens the Achilles tendon. This allows the foot to return to its normal position within 4-6 weeks without surgery.

Muscle weakness from Botox injections typically lasts 3 to 6 months. Unlike surgery, Botox does not have a long-term effect. Most types of clubfoot can be corrected with just one Botox injection. Another injection can be used if needed. There are no scars or long-term damage to the foot after Botox.

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Clubfoot in healthy babies

Very often, flat feet and clubfoot can be found in healthy boys and girls. Then doctors notice deviations from the norm when children walk - by the eversion of the foot. Clubfoot in children can be clearly visible or not visible at all. If a child places his feet incorrectly when walking, but does not complain about anything, this is still a reason to consult an orthopedic doctor.

If the doctor allows children to move normally and actively, then dancing can help cope with clubfoot; the child can walk barefoot on pebbles, sand, pile (only hard), play games that are aimed at strengthening the calf muscles and feet.

There are several effective games that can help boys and girls cope with foot defects.

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Game of Ghosts

With the help of this game you can perfectly develop coordination of movements, the muscles of the child's legs become stronger. A white sheet and a large rug with a hard fleecy surface will help the child play with benefit for himself.

One person (an adult) throws a sheet over themselves, playing the role of a ghost. The child takes off their shoes and imitates all the actions of the ghost, who moves around the room. The ghost can run, walk, sit, freeze, the child does the same so that the ghost does not notice them.

The child repeats all the actions of the ghost quietly, on tiptoe, to train the leg muscles. When the ghost turns around, the child must "defend" himself from it by jumping on one leg. This trains and strengthens the leg muscles.

"Fishing with legs"

This exercise is great for clubfoot, training the feet and ankles. You need to put the child on a chair - "river bank", from there he will fish. But not with his hands, but with his legs. You need to scatter several objects around the child, such that can be picked up with the toes. This is what the child will do, and at the same time correct the shape of the foot.

This game needs to be played every day, and then the child’s clubfoot will straighten out and the mobility of the fingers will increase.

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