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Abstract: The parents brought their 13-year-old child to the clinic, saying that the child gradually developed clubfoot after birth, and the condition became progressively more severe with age, with atrophy of the calf muscles. After 7 days of hospitalization and 6 weeks of plaster fixation, the tibial internal rotation deformity gradually recovered and the clubfoot deformity was completely corrected.
Basic information】Female, 13 years old
Type of disease】Loose clubfoot
Hospital】Harbin First Hospital
Date of Consultation】March 2022
Treatment plan】Surgical treatment (soft tissue surgery + bone surgery)
Treatment Period】7 days of hospitalization, 6 weeks of review and removal of the cast
Results】The tibial internal rotation deformity gradually recovered, and the clubfoot deformity was completely corrected.
I. Initial consultation
The parents brought their 13-year-old child to the clinic, saying that the child had gradually developed clubfoot after birth, and the condition had gradually worsened with age, with atrophy of the calf muscles. The treatment effect of this disease is relatively definite and easy not to recur, but because the time of early conservative treatment is missed, it is necessary to consider surgery to correct the clubfoot deformity, and after fully communicating with the child and parents about the difficulty and risk of surgery, surgery is determined.
II. Treatment process
Soft tissue surgery was performed to lengthen the Achilles tendon and cut the tense metatarsal fascia, while tendon transfer was performed to establish muscle balance, transpose the posterior tibial tendon, and strengthen the short peroneal tendon and cut the long peroneal tendon. Bone surgery is performed to correct the osteoarthritic deformity by internal fixation of the first metatarsal with a wedge-shaped osteotomy. A combination of soft tissue surgery and bony surgery can achieve better results in correcting clubfoot deformity. After surgery, the lower extremity was immobilized with a long-legged tubular cast to ensure dorsiflexion of the ankle joint, mild external foot elevation, and flexion of the knee joint, and the cast was removed 6 weeks after surgery.
III. Treatment results
After surgery, the tibial internal rotation deformity was gradually restored and the clubfoot deformity was completely corrected. When the anesthesia was worn out after the surgery, the child could start to move the toes actively and gradually regained sensation in the lower limbs. The swelling and pain at the surgical site were relieved significantly after 5 days, and the surgical incision was free of obvious exudation after clean drug changes. The child was discharged after 7 days of hospitalization. He was instructed to review and remove the cast after 6 weeks, and if discomfort occurred during the period, follow-up consultation was recommended.
IV. Notes
I was happy to see the child’s gradual recovery. After the surgery, it is necessary to use a cast for a long time to maintain the foot in a good position and correct the deformity. However, it is still necessary to actively move the toes during the period of cast immobilization to promote blood circulation in the lower limbs, speed up venous return, prevent deep vein thrombosis, and improve the muscle strength of the foot. After the cast is removed, muscle strength training is enhanced to correct muscle atrophy in the lower extremity. Post-operative rehabilitation training is more important for post-operative prevention of adhesions as well as joint stiffness, and needs to be adhered to for a long time. If the rehabilitation training causes swelling and pain, ice pack can be applied to the area for 30 minutes. 2-3 months after the fracture is completely healed, you can gradually walk with weight and resume normal life and work.
V. Personal insight
Neuromuscular abnormalities are also a common cause of clubfoot. The pathological changes that occur are usually continuously aggravated, and the ligaments, tendons and fascia of the foot will become shorter and contracted, with the medial and plantar muscles being the most obvious, while the peroneal muscles and foot extensor muscles will be stretched and relaxed. In the early stage of the lesion, correction by manipulation and fixation with braces can have a more desirable therapeutic effect. When the lesion progresses to a certain level, surgery is required to correct the lesion. After surgery does not mean the end of treatment, but the later rehabilitation has an important influence on the recovery effect after surgery.