CONGENITAL TALIPES EQUINOVARUS (CLUBFOOT)

CREATED BY : I DEWA PUTU BAGUS TISNA PRATAMA WIEKE SEPTINA GAMIRDA

DEFINITION
As known as Clubfoot, is a congenital deformity of the foot. The deformities are:
Fore Foot Adduction Hind Foot Varus Equinus ankle

INCIDENTIAL
1 from 1000 of birth. (In USA) Man > Woman, with 65% cases Man. 30-40% cases bilateral

CLASIFICATION
1. Postural Club foot or positional, are not true clubfeet. 2. Congenital Club foot : Simple Non-operative Rigid Operative. 3. Syndromic Club foot associated with:
- Artrogryposis Multiplex Congenital atau amioplasia. - Myelomeningocel. Pada kasus ini terjadi imbalance otot sehingga terjadi club foot tipe rigid.

ANATOMY

PATHOLOGICAL ANATOMY

PATHOLOGICAL ANATOMY

PATHOLOGICAL ANATOMY

ETIOLOGY
Idiopathic / unknown.
Persistence of fetal positioning Genetic Neuromuscular disorder

ETIOLOGY
There is also an increased risk for clubfoot associated with: Certain neurogenic conditions (spina bifida, cerebral palsy, tethered cord, arthrogryposis), Connective tissue disorders (Larsen's syndrome, diastrophic dwarfism), and Mechanical conditions (oligohydramnios, congenital constriction bands). The foot deformity seen with the above conditions is often more severe and often requires early surgical correction

CLINICAL FEATURES
The primary problem of a clubfoot is that the foot can not be placed flat on the ground so that the child can walk on the sole of the foot. The condition is not painful to the child

CLINICAL FEATURES
The three classic signs of clubfeet are: 1.) Fixed plantar flexion (equinus) of the ankle, characterized by the drawn up position of the heel and inability to bring to foot to a plantigrade (flat) standing position. This is caused by a tight achilles tendon 2.) Adduction (varus), or turning in of the heel or hindfoot 3.) Adduction (turning under) of the forefoot and midfoot giving the foot a kidney-shaped

CLINICAL FEATURES

DIAGNOSE
Clubfoot is easily diagnosed during the initial physical examination of the newborn. Oftentimes, the diagnosis of clubfoot can now be made prenatally during the 16 week ultrasound.

X-RAYS
X-rays are helpful in determining the severity of the condition. This information may become important later in trying to decide what treatment is best to recommend. X-rays are used mainly to asses progress after treatment.

TREATMENT
Immediately after diagnosis. It is important to treat clubfoot as early as possible (shortly after birth). Specific treatment will be determined by age of the child, overall health, and medical history. The long-term goal of all treatment is to correct the clubfoot and maintain as normal a foot as possible while facilitating normal growth and development of the child.

TREATMENT
CONSERVATIVE (Non-Operative). OPERATIVE.

TREATMENT
CONSERVATIVE (Non-Operative) The most commonly used treatment in the newborn and infant is manipulation and casting. This is started as soon as possible, ideally start immediately after birth The foot is manipulated to stretch and loosen the tight structures. The foot is then placed in a cast to hold it in a corrected position.

TREATMENT
CONSERVATIVE (Non-Operative) This is repeated every one week until 6-12 weeks, after that we can use special shoe until the child is under 16 years of age. The order of correction is as follows: 1. Forefoot adduction 2. Forefoot supination 3. Equinus

TREATMENT

TREATMENT

TREATMENT
OPERATIVE Three categories of Surgical Treatment: 1. Soft tissue releases that release the tight tendons / ligament around the joints and result in lengthening of the tendon 2. Bony procedures such as osteotomies / arthrodeses that divide bone or surgically stabilize joints to enable the bones to grow solidly together. 3. Tendon transfers to place the tendons, or ligaments in an improved position.

TREATMENT
OPERATIVE Indication: 1. If the manipulation / serial casting treatment fails. 2. Late Clubfoot. 3. Relapsed Clubfoot.

THANKS.