80/81: Congenital Clubfoot - Dayton Flashcards Preview

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Flashcards in 80/81: Congenital Clubfoot - Dayton Deck (17)

when in fetal development does clubfoot occur?

  • Embryonic defect
    • Occurring in first 12 weeks after fertilization
  • Temporary arrest of normal fetal development
    • During 7-8th weeks –leads to RIGID clubfoot
    • During 9-12th weeks—leads to FLEXIBLE deformity


associated congenital deformities

  • Congenital hip dysplasia
  • Metatarsus adductus of opposite foot
  • Rigid flatfoot of opposite foot (vertical talus)
  • Hand deformities
  • Spina bifida
  • Arthrogryphosis
  • Myelomeningocele


clinical features talipes equinovarus

  • Adducted forefoot
  • Varus rotated heel
  • Equinus ankle
  • Cavus forefoot
  • Small foot
  • Small calf
  • Short calf (LL discrepancy)


changes in the talus

  • Talus remains within the ankle mortise
  • navicular, cuboid, and calcaneus are medially rotated around talus but in normal relation to each other
  • Head is prominent laterally due to movement of calcaneus cuboid & navicular around it


diagram of clubfoot


is metatarsus adductus a component of clubfoot?


can be associated, but not a required component


ankle ROM clubfoot

rigid equinus

in baby you should be able to touch tibia and foot


what is the lateral prominence on club foot?

talar head


findings on AP radiograph

  • Talus and calcaneus overlap due to the medial rotation under the talus
  • Kite’s angle (talocalcaneal angle; long axis of the talus and calcaneus)
    • Normal: 20-40 degrees
    • Clubfoot: Decreased
  • Talo-1st Metatarsal angle (long axis of the first met and talus)
    • Normal: 0 to -20 degrees
    • Clubfoot: Increased >15 degrees (+ = medial)


simmons rule

  • AP Kite’s angle less than 15 degrees
  • Talar first metatarsal angle greater than 15 degrees
    • Normal is a negative angle
  • Correlates with TN dislocation in >90% of surgical specimens


lateral radiograph findings

  • Talus and calcaneus are parallel
    • Normal lateral talocalcaneal angle is about 35-50 degrees
  • Turco-Forced dorsiflexion lateral view
    • Talocalcaneal angle is typically increased but with clubfoot the angle is decreased


kites vs. ponseti

  • Kites method of individual deformity correction does not work
    • leads to surgical treatment when castings don't work: posterior medial release, piecemeal release
  • Ponseti casting method has been established as the standard


kite's treatment concepts

  • Each component of clubfoot is distinct
  • Each component is corrected separately in a stepwise approach 
    • Adduction of FF
    • Varus of calcaneus
    • Equinus
  • Cavus is corrected through pronation of the forefoot on the hindfoot


ponseti  method

  • Perfected a system of manipulation and  casting over 8 weeks to correct 95% of untreated clubfeet
  • 5-6 casts progressively more abducted with the foot supinated
  • Navicular, cuboid and calcaneus move as a unit
  • Achilles tenotomy when foot is rectus followed by 3 weeks of casting
    • don't worry babies heal quick
  • Maintain with brace for up to 2 years


ponseti's functional concepts

  • The 4 components of clubfoot are directly interrelated
  • Failure to concurrently treat cavus adduction and varus results in failure due to locking
  • The navicular, cuboid and calcaneous move as a unit under the fixed talus
  • Supination of the forefoot is required to “unlock” the joints


what should you do for equinus in clubfoot?

never cast out the equinus

tx: achilles tenotomy


maintenance of correction

  • Bar with feet abducted 70 degrees
  • Full time for 3 months
  • Nightly for 2-3 years
  • Relapses can occur, usually between 2 and 5 years
  • These are treated with manipulation and tib anterior transfer

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