Orthotic Management of Club Foot

Club foot
Definition
Clubfoot is a congenital condition that affects newborn infants, that giving gross deformity of the foot stunted lumpy appearance, which is foot turned under and towards the other foot (equinus and varus)

Causes

Muscles imbalance, some muscles are stronger then the other which makes the foot in improper position
Primarily by Congenital (Genetic & Environmental factors)
secondary to Spina bifida, Cerebral palsy, Poliomyelitis, Arthrogryposis Multiplex congenital, etc

Signs & Symptoms

Foot is turned under and towards the other foot (equinus and varus)
Short Achilles tendon
High and small heel
No creases behind Heel
Abnormal crease in middle of the foot
Foot is smaller in unilateral affection
Callosities at abnormal pressure areas
Internal torsion of the leg
Calf muscles wasting

Treatment

Treatment for clubfoot usually starts at birth. The goal of treatment for clubfoot is to obtain a plantigrade foot that is functional, painless, and stable over time, as well as cosmetically pleasing appearance. Correction of the deformity is to strengthen the weak muscles and weakened the strong muscles.

There are three types of treatment to correct the deformity, those are:

Manipulation
Exercise
Surgery
To maintain the correction, following method can be use
Plaster Cast
Orthosis / Splint
Bandaging

Orthosis

Orthosis is used to maintain the correction, the foot is first to be manipulated into maximal correction can be tolerated, and then the corrective position of the manipulation is maintained by the splint. Orthosis also can be prescribed post surgery, to maintain the correction done by surgery.

Orthotic options:

a. Dennis Brown splint
The splint is set at 60 to 70deg of external rotation, and 50 Dorsiflexion
b. Ankle Foot Orthosis
It can be used if the deformity is already reduced, and the child needs to walk.
c. Knee Ankle foot Orthosis set in 90deg knee Flexion
Maintain the foot abducted and externally rotated. 90deg knee flexion position to reduce the tension of gastrocnemius, which make easy to correct the equinus.

Complications

Fix deformity of Talipes Equino Varus
Patient walk with lateral border of foot touching the ground

Orthotic Treatment post complication

Fixed deformity cannot be corrected when it is neglected, the orthotic objectives are to accommodate the deformity and enhance mobility. Ankle Foot Orthosis which provide accommodation to the deformed foot can be prescribe to the patient

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