Overview
Congenital clubfoot is a common congenital foot deformity. It is more common in males and can be unilateral or bilateral. The deformity is obvious and can be detected at birth, so cases of negligence are rare and can be treated early with good results. The etiology of the disease is still unknown.
Clinical manifestations
1.Unilateral or bilateral foot deformities of varying degrees appear after birth, with ankle flexion, inversion and inversion deformities.
2.When the child learns to walk, he walks on the forefoot or the lateral edge of the foot, and as he grows older, the deformity worsens, and in severe cases, he walks on the back of the foot, and bursa and callus appear at the weight-bearing area.
3.X-ray film, front and side view of the affected foot: after birth, the ossification center of the talus, heel bone and dice bone can be seen on the X-ray film, and sometimes the third cuneiform bone can be seen, all the bones and toe bones have appeared, while the tarsal navicular bone does not appear until the age of 3 years.
4, . The deformity is estimated according to three lines: (1) the angle of heel spacing is measured on the orthopantomograph, if it is less than 30°, it indicates that there is no inversion of the foot; (2) the angle crossed by the longitudinal axis of the first bone and the longitudinal axis of the talus is measured, the normal is 0°-20°; (3) the angle formed by the longitudinal axis of the talus and the face of the heel is measured on the lateral X-ray, the normal is 35°-55°, if If it is less than 30°, it indicates foot drop. If the heel angle is less than 15° and the angle formed by the intersection of the first bone and the longitudinal axis of the talus is greater than 15°, it indicates a subluxation of the talonavicular joint (Simon’s 15° law).
Diagnosis basis
1. Infants are born with one or both sides of the foot flexion inversion deformity.
2. The anterior part of the foot is inwardly turned, the talus is flexed, the heel is inwardly turned and flexed, and the Achilles tendon and fascia are contracted. The forefoot becomes wider, the heel becomes narrower, and the arch of the foot is high. The outer ankle is protruding in front, and the inner ankle is posterior and not obvious.
3.When standing and walking, the outer edge of the foot is weight-bearing, and in severe cases, the outer edge of the dorsal foot is weight-bearing, and bursitis and callus are produced in the weight-bearing area.
4.Unilateral deformity, walking limp, bilateral deformity, walking wobbly.
5.X-ray radiograph: the talus crosses the first bone longitudinal axis at an angle greater than 15°, and the angle between the heel surface and the talus longitudinal axis is less than 30°.
Treatment principles
1.The earlier the treatment, the better the effect. The treatment method varies according to the age and degree of deformity.
2.Manipulation method: generally suitable for those who are less than 6 months old or lighter. It starts from birth, the earlier the better. The physician should teach the mother or lead the child to correct the anterior inversion of the foot first, then correct the inversion of the subtalar joint, and then correct the flexion of the ankle joint. The technique should be gentle so as not to damage the epiphysis. Each corrected position is held for 10 seconds, 10-15 minutes each time. Operate Yuan times daily, and generally advocate to do before breastfeeding.
3.Plaster tubular external fixation correction: adapted to 3 months-1 year old every 2-3 months to replace.
4.Surgical treatment, suitable for more than 6 months, the manipulation can not be corrected. The operation style varies according to age. (1) Medial posterior soft tissue release of the foot, for children aged 6 months to 6 years. (2) Lateral column shortening, for children over 3 years of age with severe deformity, with heel dice joint dice or heel wedge resection, or lateral heel wedge osteotomy at the same time as medial and posterior soft tissue release. (3) Triple joint fusion is suitable for patients above 12 years old with severe deformity.
Principle of medication
There is no special drug treatment for congenital clubfoot, such as surgery, postoperative application of antibacterial agents to prevent infection.
Auxiliary examination
1, congenital clubfoot is not difficult to diagnose, X-ray is a necessary examination special case;
2, if hospitalized for surgery, three routine tests such as blood tests are necessary, and B tests can be considered as appropriate depending on the condition of the child.
Evaluation of treatment effect
1.Cure: basic correction of foot deformity, basic recovery of function, wound healing after surgery.
2.Improved: the deformity is mostly corrected by manipulative treatment or surgery.
3.Not healed: no improvement of deformity.