Clubfoot

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

What is clubfoot?

The clubfoot, which is qualified as congenital, is due to certain diseases: skeletal dysplasia, namely, dysostosis, arthrogryposis, osteochondrodysplasia. Another clubfoot can provoke such defects and malformations of the support apparatus, as one-sided or bilateral longitudinal ectromelia.

Clubfoot physicians diagnosed as an independent separate from other disease. The highest percentage of clubfoot is congenital, with other deformities of the legs or hands. The clubfoot can progress if no action is taken.

If the clubfoot is clearly visible, then the foot turns inside. And the outer edge of the foot is turned back and down. The inner edge of the foot turns upward. The rear of the foot is turned down and forward. The plantar part of the foot is above and behind. As for the supination of the foot, it is broken so severely that the heel sometimes touches the inside of the shin.

The clubfoot is also characterized by the twisting of the shin bones in the outward direction (this is called the torso), lyuo the inflection of the sole across (called inflection). At the same time, a transverse furrow forms in the middle of the foot, it is called the Adams furrow.

The clubfoot may also be accompanied by cones or bones on the legs - they are called valgus deformity of the big toe. Doctors distinguish the degree of clubfoot: light, medium and heavy. With an easy clubfoot, the ankle movements are preserved, so the deformation of the foot can be easily corrected. With an average degree of club foot, foot movements are no longer so easy, and their correction is required, with the disease you can fight, but only partially. With a heavy degree of clubfoot, surgery is needed - manual methods will not help.

When a person is diagnosed clubfoot, not only the form of the foot is broken, but its functions are limited. Especially the function of motion, not only the feet, but also the entire leg.

Acquired clubfoot

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ICD-10 code

M21.S. Purchased koggeobraznaya brush, horsewhip, a hollow foot (with a high vault) and a curved foot (clubfoot).

Acquired clubfoot develops much less often congenital.

What causes the acquired clubfoot?

The causes of clubfoot may be damage to the foot bones 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 previous deformation of the disease.

How is the acquired clubfoot treated?

The choice of treatment tactics in each case is individual. With the acquired clubfoot, it is not necessary to count on the success of the treatment, applying the stage cast plaster casts and redressions.

In case of paralytic clubfoot due to injury of the peroneal nerve and muscles or poliomyelitis, deformation is eliminated by restoration of the tendons and damaged nerve or by transplantation of the tendon of the anterior or posterior tibial muscle onto the external surface of the foot. Possible arthrodesis. In children of older age, a subterranean and heel-huboid arthrodesis gives a favorable result.

In cicatricial after-burn deformations, there is a need for excision of scars, restoration of tendons and cutaneous autoplasty.

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

Causes of clubfoot

There are various reasons for clubfoot, depending on the medical classification. Clubfoot may be caused by genetic factors such as Edwards Syndrome, a genetic defect due to the chromosome at number 18. From this defect, girls suffer three times as often as boys. In the risk group, children born to elderly mothers over 45 years of age.

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

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The theory of clubfoot

There are several theories about what are the causes of clubfoot. It can have hereditary roots or can be caused by a defect in the ovule during the conception of the child. The clubfoot sometimes appears as a result of paralysis. In the soft form, the clubfoot gives slight changes in the structure of the foot; in more severe cases it is necessary to involve orthopedic methods of treatment. Although clubfoot is usually congenital, sometimes in a child older the clubfoot may be caused by trauma or poliomyelitis.

Treatment - consequences and prospects

General restorative treatment is often not enough to correct the clubfoot of the child. Surgical interventions may be necessary to correct the structure of tendons, ligaments and joints of the foot and ankle. Typically, before the 9-month or 12-month-old child, the operation usually corrects clubfoot.

This is good for the muscles of the child's leg, to try to return the position of the foot with clubfoot, you need also special shoes or curly braces, which are usually used for walking for a year or more after the operation. Surgery is likely to lead to more leg stiffness than non-surgical treatment, especially over time.

If you do not treat clubfoot

Without any treatment, clubfoot can lead to serious changes, even disability, but after treatment the child can have almost normal legs. The child will be able to run and play without pain and wear normal shoes. Corrected clubfoot still will not be perfect, but clubfoot, as a rule, makes the leg a couple of sizes smaller and slightly less mobile than a normal leg. Calf leg muscles with club foot also become smaller.

Long-term studies show that in some cases clubfoot may require additional surgery. Although there is a medical dispute about the effectiveness of such operations, in the light of the prevalence of relapse after previous operations.

Famous people with club foot

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

The Nazi propaganda minister Joseph Goebbels was born with a deformity of the foot, suffered an unsuccessful operation to remove the bacterial infection after osteomyelitis, which the doctors mistakenly mistook for clubfoot. He walked with a short leg.

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Features

Without the treatment of clubfoot, patients often can not walk due to deformation of the ankle, one or both at once. It is an inborn defect, because of which approximately one person from every 1000, born with this defect, suffers. Approximately 50% of cases of clubfoot are bilateral. In most cases this is not an isolated disease. In men, it happens more often than in women in a ratio of 2: 1. And clubfoot is manifested in animals, especially in horses.

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Treatment of clubfoot

Clubfoot is treated with the manipulations of pediatricians, the services of a physiotherapist, orthopedic surgeon, traumatologist are also needed.

Sometimes staples are required to keep the legs in the right positions. It may also be necessary to use gypsum or tires that are placed on the knees, ankles of the feet. Other variants of orthopedics also include conservative methods, to which traumatologists in our country tend the most.

Stepwise gypsum

First, the doctor kneads the foot by manual manipulation. But force receptions are counter-indicative: soft manipulations are necessary, without force receptions. As soon as the stop is slightly adjusted, its position is gradually corrected, a plaster boot is applied to the foot. It is superimposed on the foot just above the foot and above the knee. When a certain time passes, the doctors remove the boot and start working again with the foot, correcting its position further. Then - again a plaster boot, and so a few more steps.

Such treatment is used in the first year of life of a boy or girl and lasts for a year. As a rule, the stop comes back to normal. Then the child needs orthopedic shoes, so that the foot does not return to the wrong position again. Otherwise the baby's leg will grow and in uncomfortable shoes it risks growing irregularly.

Recovery time of foot

At different stages of treatment and in different medical institutions, the timing of treatment is different. Orthopedists who adhere to conservative methods of treatment, can insist that from time to time gypsum stops up to 14-15 years. But sometimes they use surgical treatment. Then the restoration of the foot can take up to six months. True, the operation should be carried out at an early age - from three months to six months.

You can also use plastic tendons by Zatsepin. Then the leg is in plaster for 3 months, and this plaster is applied above the knee. After removing the bandage, a rehabilitation course is carried out. Then the gypsum is again for 3 months and again the rehabilitation course.

Of course, in each case the terms of rehabilitation are different, but in most cases, extensive operations are not required to treat clubfoot. Extensive surgery can lead to developing scar tissue inside the baby's leg. Scars can lead to functional growth and aesthetic problems of the foot, because the scars on her tissue will interfere with normal movements. A child who has undergone extensive surgery, on average, carries two additional surgeries to eliminate the problems that are presented above.

Treatment of clubfoot without surgery

Treatment of clubfoot should begin almost immediately after it is diagnosed in order to get a chance for a successful outcome without surgery. Over the past 10-15 years, great progress has been made in correcting clubfoot without surgical intervention.

Over the past decade, functional physical therapy is often used by stretching the tendons and muscles of the foot and bringing it to the right position. In comparison with the results of patients who underwent surgery, non-operative manipulations with the foot are more effective. The results of these studies were presented at national and international conferences, for example, in the Children's Orthopedic Society of North America at the International Symposium on the treatment of clubfoot.

Staples

After correcting the results, a servicing foot correction could require full working hours (24 hours a day). Good results are obtained by using cleavage and staples on both legs, regardless of the localization of clubfoot - where it is on one side or both, for several weeks after treatment.

Part of the time is spent for using staples (usually at night for 12 hours) - for up to 4 years. Without constant foot correction, the clubfoot will almost certainly be repeated, because the muscles around the foot can bring it back to the wrong position.

Approximately 20% of children may need surgical correction of the tendon of the foot after two years of manual manipulation. This requires general anesthesia by the method of small surgery, avoiding the impact on the joints of the legs.

Botox

Botox is also used as an alternative to surgery. Botox is the name of a botulinum toxin type A, a chemical substance, it affects the nerves of the legs that control the muscles. This causes muscle weakness by preventing muscle contractions. As part of the treatment of clubfoot, Botox is introduced into the gastrocnemius muscle of children. In a period of about a week botox weakens the Achilles tendon. This allows the leg to return to its normal position for 4-6 weeks without surgery.

The muscle weakness after botox injection, as a rule, lasts from 3 to 6 months. Unlike surgery, botox has no lasting effect. Most types of clubfoot can be corrected with just one botox injection. You can use another injection, if necessary. After Botox, there are no scars or long-term damage to the leg.

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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 - on the turn of the foot. The clubfoot in children can be easily seen or not visible at all. If a child makes a wrong foot when walking, but does not complain about anything, it's still an excuse to consult an orthopedic doctor.

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

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

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Playing in the ghosts

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

One person (an adult) throws a sheet on himself, playing the role of a ghost. The child takes off his shoes and repeats all the actions of the ghost, which moves around the room. A ghost can run, walk, sit, die, the child does the same, so that the ghost does not notice him.

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

"Fishing with the feet"

This exercise perfectly helps with clubfoot, training the feet and ankles. It is necessary to put the child on a stool - "bank of the river", from there he will fish. But not with your hands, but with your legs. You need to scatter around the child a few items, such that you can lift your toes. This, and will deal with the child, and at the same time and correct the shape of the foot.

This game needs to be spent every day, and then the child will have a flattened foot leveling and the mobility of the fingers will increase.

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