80/81: Congenital Clubfoot - Dayton Flashcards Preview

Surg+BioMech [all exams] > 80/81: Congenital Clubfoot - Dayton > Flashcards

Flashcards in 80/81: Congenital Clubfoot - Dayton Deck (17)
1

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

2

associated congenital deformities

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

3

clinical features talipes equinovarus

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

4

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

5

diagram of clubfoot

6

is metatarsus adductus a component of clubfoot?

no

can be associated, but not a required component

7

ankle ROM clubfoot

rigid equinus

in baby you should be able to touch tibia and foot

8

what is the lateral prominence on club foot?

talar head

9

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)

10

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

11

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

12

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

13

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

14

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

15

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

16

what should you do for equinus in clubfoot?

never cast out the equinus

tx: achilles tenotomy

17

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

Decks in Surg+BioMech [all exams] Class (68):