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, but the deformity is also prone to recurrence and should be followed regularly until skeletal maturity, about 14 years of age. The etiology is still unknown.
[Etiology].
There are a number of hypotheses about the etiology of this disease, such as environmental factors, embryonic developmental malformations and genetics, but all are difficult to be sure.
Bōhm believes that the fetal foot develops in the embryo from a horseshoe, inversion, and inversion position to a normal position gradually. Dunn suggests that the deformity is due to compression of the fetus in utero, resulting in compression of the anterior part of the foot in the inversion, rotation, and ptosis positions, and Stewart observed a higher incidence in the Japanese-American population of the Hawaiian Islands, who are accustomed to sitting with the foot in the inversion position. Wynne-Davis concluded from a family survey of 144 cases from a genetic perspective that some of these were genetic abnormalities, but no pattern of dominant or recessive genetic inheritance has been identified. Other theories, such as Stewart’s suggestion of an abnormal muscle stop, Moore’s finding of a neurological abnormality, and Sherman’s suggestion of a malformation of the talus, have been suggested. The present-day view is that a complex combination of factors produces different degrees of deformity and is never a single cause.
[Clinical manifestations].
1.Unilateral or bilateral foot deformities of varying degrees appear after birth, with the foot in an ankle flexion position, inversion, and inversion deformity.
2. When the child learns to walk, he walks with the forefoot or the lateral edge of the foot, and as he grows older, the deformity gradually worsens, and in severe cases, he walks with the back of the foot, and bursa and callus appear at the weight-bearing place.
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. Estimation of deformity according to three lines.
(1) Measurement of the heel spacing angle on the orthopantomogram; if it is less than 30°, it indicates that the foot is not pronated.
(2) Measurement of the angle crossed by the longitudinal axis of the first bone and the longitudinal axis of the talus, which is normally 0°-20°.
(3) X-ray lateral radiographs measure the angle formed by the longitudinal axis of the talus and the heel surface, normal 35°-55°, if it is less than 30°, it indicates foot dropout. If the angle of talus heel 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 talocalcaneal subluxation (simon15° law).
[Diagnosis].
1, The infant was born with one or both side of the foot flexion-inversion deformity.
2, The forefoot is inwardly inwardly turned, the talus is flexed, the heel is inwardly flexed, the Achilles tendon, and the fascia is contracted. The forefoot becomes wide, the heel becomes narrow and small, and the arch 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 sway.
5.X-ray: 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].
1, from birth, the earlier the treatment, the better the effect. The treatment method varies according to the age and the degree of deformity. At present, the international and domestic more uniform understanding, early ponseti orthopedic plaster method of treatment of neonates and infants with clubfoot satisfactory results. Our hospital has been routinely carried out.
2, the method of manual correction: newborns are born, the earlier the better. The physician teaches the mother or leads the child to first correct the anterior inversion of the foot, 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. Several times a day, before breastfeeding is generally advocated.
3.ponsetti plaster cast external fixation correction: adapted to the newborn to infant stage, the cast needs to be changed regularly, usually 4-5 times plaster orthosis is needed, some infants need to do a percutaneous Achilles tendon cut and lengthen minor surgery.
4.Surgical treatment, suitable for early delayed treatment or late recurrence, the cast can not be corrected. The operation style varies according to age.
(1) Soft tissue release of the medial posterior aspect 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 the medial and posterior soft tissue release.
(3) Triple joint fusion is suitable for patients over 12 years old with severe deformity.
[Prognosis].
1.Cure: basic correction of foot deformity, basic recovery of function, wound healing after surgery.
2.Improved: the deformity is mostly corrected by manual treatment or surgery.
3.Unhealed: no improvement of deformity.