Manual orthopedic treatment of congenital clubfoot

Methods: Within one or two weeks of treatment in the hospital, we formulated corresponding rehabilitation procedures for the characteristics of foot deformity and different periods of time of each child, explained them in detail to the parents, and taught them the correct corrective techniques, so that the parents could closely cooperate with them, and the treatment procedures could be effectively carried out and implemented. At home, the following methods should be carried out: the focus of foot manipulation correction is placed on the three parts of the deformity, that is, the first correction of forefoot adduction (the right side of the affected foot as an example), the child is flexed at the hip and knee, abduction and external rotation position. The talar head is stabilized to abduct the foot; by positioning the talar head, all parts of the clubfoot deformity are corrected at the same time, with the exception of plantarflexion of the ankle. When the heel inversion is corrected and the plantar flexion is corrected, the left thumb is placed on the head of the talus, the index and middle fingers wrap around the heel, the right thumb is placed on the bottom of the foot, and the middle and index fingers are fixed from the medial side of the lower leg, and the fingers are coordinated with the right thumb to pull the foot outward and upward with a sustained force, and part of the force is used for valgus or dorsiflexion, and the force is gradually increased to reach the appropriate position. Each time when performing the manipulation correction, you can rest for a moment every 3-5min, and then repeat the above actions, according to the situation of the beginning can be 2 times / d; 1 month later changed to 1 time / d; 3 months later can be every other day; manipulation of the corrective action must be moderate, can be operated when the child into the milk or sleep foot is very relaxing, and every two or three weeks to the hospital for review. In addition, fingers or toothbrushes can also be used to stimulate the medial and plantar aspect of the foot, so that the foot can be actively abducted and dorsally extended to increase local mobility and muscle strength. After each manipulation, the foot should be immobilized in a functional position with a bandage and adhesive tape, so that the tight soft tissues can be stretched to maintain the effect of manipulation. There are two methods: French method and Ponseti method. In this method, a cotton pad about 0.5 cm thick is used to wrap the affected foot, calf and lower and middle part of the thigh as a liner, and then an ordinary elastic bandage is used to wrap the foot. Starting from the dorsal side of the first metatarsal head, wrapping around the medial side of the foot, metatarsal base, lateral side of the foot, dorsum of the foot and backward upward wrapping around the heel of the foot, calf, and up to the distal 1/3 of the thigh, the bandage can be wrapped around the mid-anterior foot for 2-3 times, and the strength of which the child can withstand is appropriate, and make the inward deformity to be corrected to a mild degree. The bandage is wrapped upward to the thigh mainly for orthopedic fixation. When the affected foot plantarflexion close to zero ° should be changed to “8” bandage, the proximal end is fixed in the upper part of the calf near the N fossa. It should be noted that the distal end of the toes should be exposed, in order to observe whether the blood circulation of the toes is good, if the toes are found to be pale or have bruises, immediately remove the elastic bandage and cotton pads. After 12-16 weeks of manipulation and bandage fixation, orthopedic support can be worn all day long. The purpose of the brace is to maintain the foot in the post-treatment position of abduction, pronation and dorsiflexion as much as possible and to maintain and consolidate the effect of the manipulative correction. The brace is usually worn when the foot can stand and walk and sleep, and should be worn for more than two years to promote the recovery of function as soon as possible and to prevent recurrence of the deformity. The treatment cycle of this study was 4-5m, i.e., 1m after wearing the orthopedic support club. Correction criteria: forefoot adduction, inversion and heel inversion were corrected (i.e., foot abduction reached 50-70°, heel inversion was 0°); the horseshoe of the talocalcaneal joint disappeared (the foot dorsiflexion reached 10-40°); the foot could be easily moved in any direction when it was lax; the front of the foot could be pushed to reach the correct position; the bottom of the foot was relatively flat and showed an outer The foot is flat on the bottom of the foot, and the heel is flat on the back of the foot, which is considered to be cured. The improvement of forefoot pronation, pronation and calcaneal inversion, heel drop, and partially restricted movement of the talocrural joint were considered effective.