Clubfoot

Question 1

what is it?

Answer 1

TALIPES EQUINOVARUS

Question 2

pathogenesis

Answer 2

in utero abnormal alignment of joints between talus, calcaneus, navicular -contractures of the soft tissues (ligaments, capsule & tendons) - ankle equinus (plantarflexion)supination of forefootvarus alignment of the forefoot

Question 3

who gets it?

Answer 3

boys:girls 2:1 genetic link - +ve Fhx more common in breech presentation oligohydramnios - another risk factor occasionally part of another skeletal dysplasia 50% bilateral

Question 4

how is it investigated?

Answer 4

diagnosis usually obvious

Question 5

how is it managed?

Answer 5

early splintage – Ponseti technique: progressive correction, 5-6 weekly cast changeso 80% require a tenotomy of Achilles tendon to maintain full correctiono full correction achieved: brace consisting of boots attached to a bar - 23 hours a day for 3 months- during sleep until the age of 3-4 (prevent recurrence) delayed presentations – uncommon – can result in fixed deformity = walking outside of footlate deformity very difficult to correct: extensive surgery (soft tissue +/- bony procedures)surgery may be required for cases resistant to splintage