Horseshoe foot, if not relieved in time, may cause secondary problems such as ankle contracture, lower limb inequality, pelvic tilt, and scoliosis.
Why do I need to fix it with a cast?
The main purpose of plaster fixation is to maintain and fix the corrected position and gradually restore the original normal shape of the foot.
Warm tip: Plaster fixation is usually for 4-6 weeks and should not be removed prematurely.
First of all, what are the diagnostic bases of clubfoot?
Diagnosis basis.
1, the infant is born with one or both feet plantar flexion inversion deformity.
2, the front part of the foot inward and inward, talus plantarflexion, heel plantarflexion inward, Achilles tendon, metatarsal fascia contracture; forefoot widening, the heel becomes narrow sacred, the arch is high, the outer edge of the foot convex; outer ankle is protruding in front, the inner ankle is posterior and not obvious.
3.Weight-bearing on the outer edge of the foot when standing, and in severe cases, weight-bearing on the dorsal side of the foot, producing bursa and callus in the weight-bearing area.
4.Unilateral deformity, walking with limp; bilateral deformity, walking with sway.
5.X-ray showed that the talus was not parallel to the longitudinal axis of the first metatarsal and the heel bone was not parallel to the longitudinal axis of the 4th and 5th metatarsals and formed an angle; the angle between the talus and the longitudinal axis of the heel bone was less than 30° (normal is 30°~35°).
The patient was a female and was admitted to the hospital with the diagnosis of left lower limb deformity. Relevant examination was done after admission, and the skin was prepared routinely before surgery.
Plaster fixation precautions.
1, pay attention to ensure that the cast is long enough, not to remove the cast fixation too early.
2, pay attention to keep the elasticity of the plaster bandage.
3, pay attention to the amount of exercise when carrying out functional exercises, to exercise without feeling fatigue as the degree.
Horseshoe foot formation: mainly due to the foot muscle imbalance, that is, inversion muscle (tibialis anterior and tibialis posterior) strong and short, external rotation muscle (peroneal muscle) weak and elongated, plantar flexor muscle (calf triceps) is stronger than the dorsal flexor muscle (tibialis anterior). The imbalance of the muscles formed a deformity of the bone and joint over time, and the deformity was aggravated by weight-bearing on the basis of the deformity.
The patient was a male and was admitted to the hospital with the diagnosis of right lower limb deformity. Figure 1 shows the patient’s preoperative appearance.
One week after admission, the director made the surgical plan and performed the orthopedic surgery with Ilizarov.
Pre-operative preparation.
1.Adjust the external fixator frame according to the patient’s limb and sterilize it.
2. Routine skin preparation.
3.Psychological care.
Health instruction.
1.Do not place heavy objects on the surface of the plaster to avoid plaster fracture and deformation.
2.Guidance to patients and family members on functional exercise of fixed parts to prevent muscle atrophy of the affected limb. 3.Attention to the aura manifestation of impaired blood circulation of the limb.
4.Keep the plaster breathable.
Congenital clubfoot is a common congenital foot deformity. It is a combination of three main deformities: foot drop, inversion, and inversion. Hind foot horseshoe, inversion, inward rotation, forefoot inversion, inversion, high arch as the main manifestation of the deformity disease. It is more common in males and can be unilateral or bilateral. The case I collected this time is congenital clubfoot. The patient was a female and was admitted with the diagnosis of congenital bilateral clubfoot deformity.
Care measures after plaster fixation.
1. Elevate the pad under the affected limb about 20 cm above the level of the heart to promote blood and lymphatic reflux and prevent or reduce the swelling of the patient’s limb.
2.Check the skin at the edge of the plaster to observe whether there is redness, swelling, friction and other manifestations.
3.Closely observe the blood circulation in the distal part of the affected limb, the sensation and movement of the affected limb. If the affected limb has severe pain, numbness, pale or purple skin color, the cast should be removed immediately and the blood flow obstruction should be treated urgently.
4.If there is blood seeping onto the surface of the cast, the blood border can be marked well and the time can be indicated so as to observe whether the bleeding continues later.
5.If there is a bad smell emitted from the cast, it indicates that there may be pressure sores or even wound infection in the cast, and corresponding treatment should be given promptly.