Nursing Presentation.

1. CLUB FOOT
Presented By :-
Sushant

2. INTRODUCTION
 Talipes :- Latin talus (ankle) + pes (foot).
 Equino :- indicates the heel is elevated (like a horse's)
 varus :- indicates it is turned inward.
 It is a congenital malformation of the lower
extremity that affects the lower leg, ankle, and foot.
 Club foot, also called congenital talipes equinovarus
(CTEV), is a congenital deformity involving one foot
or both. The affected foot appears to have been
rotated internally at the ankle.

4.  Without treatment, people with club feet often
appear to walk on their ankles or on the sides of
their feet. However with treatment, the vast
majority of patients recover completely during early
childhood and are able to walk and participate in
athletics.
 Approximately half of people with clubfoot have it
affect both feet, which is called bilateral club foot.
 It occurs in males twice as frequently as in females.
 Because of poverty, lack of education and
socioeconomic reasons many of our children (more
than 60%) are neglected and remain untreated.

5.  3 basic components:-
(i) ankle joint plantarflexed/equines
(ii) subtalar joint inverted/varus
(iii) forefoot adducted
 Mainly three bones are affected ;
 1.TALUS
 2.CALCANEUS
 3.NAVICULAR

6.  By the time we detect them during camps, they are
already grown up (5 to 18 years of their life). With
this age bones are deformed to great extent and
deformities become severe and rigid which are
difficult to correct.
 Also there is a large group of children who get
inadequate treatment and deformities recur.
 3 basic components :-
(i) ankle joint plantarflexed/equines
(ii) subtalar joint inverted/varus
(iii) forefoot adducted

7. INCIDENCE
 The overall prevalence of clubfoot was 1.29 per 1,000
live births, with 1.38 among non-Hispanic whites, 1.30
among Hispanics, and 1.14 among non-Hispanic blacks
or African Americans.
 In India, out of those children who have born with this
deformity only 20- 25% of children from urban areas,
get proper care and treatment and get cured of the
disease. Rest of the children either remains untreated
(neglected); or even if some of them are treated, they
get recurrences and remain disabled for the life.
 children with clubfoot born per year:
30,000(india)

8. DEFINITION
 Clubfoot describes a range of foot abnormalities
usually present at birth (congenital) in which a
baby's foot is twisted out of shape or position.
 In clubfoot, the tissues connecting the muscles to
the bone (tendons) are shorter than usual. The
term "clubfoot" refers to the way the foot is
positioned at a sharp angle to the ankle, like the
head of a golf club.
 Despite its look, however, clubfoot itself doesn't
cause any discomfort or pain.

10. Infant with unilateral clubfoot Infant with bilateral clubfoot

11. CAUSES
 The cause of clubfoot is unknown (idiopathic). But
scientists do know that clubfoot is not caused by the
position of the baby in the womb (fetus).
 In some cases, clubfoot can be associated with
other abnormalities of the skeleton that are present
at birth (congenital), such as spina bifida.
 Clubfoot can also be the result of problems that affect
the nerve, muscle, and bone systems, such as stroke or
brain injury.
 Extrinsic associations include teratogenic agents
(eg, sodium aminopterin), oligohydramnios, and
congenital constriction rings

12.  It has been proposed that idiopathic CTEV in
otherwise healthy infants is the result of a
multifactorial system of inheritance .
 syndromes involving chromosomal deletion.
 The environment plays a role in causing clubfoot.
 Studies have strongly linked clubfoot to cigarette
smoking during pregnancy, especially when there
already is a family history of clubfoot.
CAUSES…..

13. RISK FACTORS
 Risk factors include:
 Sex. Clubfoot is more common in males.
 Family history. If either one of the parents or their
other children have had clubfoot, the baby is more
likely to have it as well. It's also more common if the
baby has another birth defect.
 Smoking during pregnancy. If a woman with a family
history of clubfoot smokes during pregnancy, her
baby's risk of the condition may be 20 times greater
than average.

14. RISK FACTORS……
 Not enough amniotic fluid during pregnancy.
Too little of the fluid that surrounds the baby in
the womb may increase the risk of clubfoot.
 Getting an infection or using illicit drugs during
pregnancy. These can increase the risk of
clubfoot as well.

15. TYPES
 Talipus varus: inversion or bending inward of
foot.
 Talipes valgus: eversion or bending outward
of foot.
 Talipes equinus: planter flexion and toe is
lowe than heel.
• Talipes calcaneous: dorsiflexion, toe is higher
than heel. Treatment requires stretching:
plantarflex and invert foot, excellent
prognosis

17. SYMPTOMS
 If a child has clubfoot, his or her foot may have
the following appearance:
 The top of the foot is usually twisted downward
and inward, increasing the arch and turning the
heel inward.
 The foot may be turned so severely that it actually
looks as if it's upside down.
 The calf muscles in the affected leg are usually
underdeveloped.
 The affected foot may be up to 1/2 inch (about 1
centimeter) shorter than the other foot.

18. COMPLICATIONS
 Clubfoot typically doesn't cause any problems until a
child starts to stand and walk. If the clubfoot is treated,
the child will most likely walk fairly normally. He or she
may have some difficulty with:
 Mobility. The child's mobility may be slightly limited.
 Shoe size. The affected foot may be up to 1 1/2 shoe
sizes smaller than the unaffected foot.

19.  However, if untreated, clubfoot causes more-serious
problems. These can include:
 Arthritis. The child is likely to develop arthritis.
 Poor self-image. The unusual appearance of the foot may
make the child's body image a concern during the teen
years.
 Inability to walk normally. The twist of the ankle may not
allow the child to walk on the soles of the feet. To
compensate, he or she may walk on the balls of the feet,
the outside of the feet or even the top of the feet in
severe cases.
 Muscle development problems. These walking
adjustments may prevent natural growth of the calf
muscles, cause large sores or calluses on the feet, and
result in an awkward gait.

20. DIAGNOSIS
 Most commonly, a doctor recognizes clubfoot soon
after birth just from looking at the shape and
positioning of the newborn's feet. Occasionally, the
doctor may request X-rays to fully understand how
severe the clubfoot is, but usually X-rays are not
necessary.
 It's possible to clearly see some cases of clubfoot
before birth during a baby's ultrasound examination. If
clubfoot affects both feet, it's more likely to be seen in
an ultrasound. While nothing can be done before birth
to solve the problem, knowing about the condition may
give time to learn more about clubfoot and get in touch
with appropriate health experts, such as a genetic
counselor or an orthopedic surgeon.

22. TREATMENT
 As the newborn's bones and joints are extremely flexible,
nonsurgical treatments such as casting or splinting are
usually tried first. The foot (or feet) is moved (manipulated)
into the most normal position possible and held
(immobilized) in that position until the next treatment.
 This manipulation and immobilization procedure is
repeated every 1 to 2 weeks for 2 to 4 months, moving the
foot a little closer, to a normal position each time.
 The goal of treatment is to improve the way the child's foot
looks and works before he or she learns to walk, in hopes
of preventing long-term disabilities. Treatment options
include:

23.  1. Stretching and casting (Ponseti method)
 This is the most common treatment for clubfoot.
The doctor will do the following:
 Move the baby's foot into a correct position and
then place it in a cast to hold it in that position .
 Reposition and recast the baby's foot once or twice
a week for several months .
 Perform a minor surgical procedure to lengthen the
Achilles tendon (percutaneous Achilles tenotomy)
toward the end of this process .

24. Percutaneous
Achilles
tenotomy
Casting

25. OTHER BRACES & CASTS…..

26. Wheaton
Brace
Dennis Brown
Bar

27.  2. Stretching and taping (French method)
 This approach is also called the functional method or the
physiotherapy method. Working with a physical therapist,
parents:
 Move the foot daily and hold it in position with adhesive
tape .
 Use a machine to continuously move the baby's foot while
he or she sleeps .
 After two months, cut treatment back to three times a week
until the baby is 6 months old .
 Once the shape is corrected, continue to perform daily
exercises and use night splints until the baby is of walking
age .
 This method requires a much greater time commitment
than does the Ponseti method. Some caregivers combine
the French method and the Ponseti method.

28.  Surgery
 In some cases, when clubfoot is severe or doesn't
respond to nonsurgical treatments, babies may
need more invasive surgery. An orthopedic
surgeon can lengthen tendons to help ease the
foot into a better position. After surgery, the child
will be in a cast for up to two months, and then
need to wear a brace for a year or so to prevent
the clubfoot from coming back.
 Even with treatment, clubfoot may not be totally
correctable. But in most cases babies who are
treated early grow up to wear ordinary shoes and
lead normal, active lives.
 Usually done at 9 to 12 months of age.

31. PREVENTION
 Because doctors don't know what causes clubfoot,
we can't completely prevent it. However, during
pregnancy, things to limit baby's risk of birth defects,
include:
 not smoking or spending time in smoky
environments
 not drinking alcohol
 avoiding drugs not approved by your doctor

32. NURSING MANAGEMENT
Postoperative nursing considerations:-
 Neurovascular checks at least every 2 hours
 Observe for any swelling around cast edges
 Elevate ankle and foot on pillows
 Pain management
(analgesics)

33.  Doing stretching exercises with baby.
 Putting child in special shoes and braces.
 Making sure the child wears the shoes and
braces as long as needed — usually full time
for three months, and then at night for up to
three years .

34. SUMMARY

35. BIBLIOGRAPHY
 http://www.webmd.com/a-to-z-
guides/clubfoot-topic-overview
 http://www.webmd.com/a-to-z-
guides/clubfoot-topic-overview?page=2
 http://en.wikipedia.org/wiki/Club_foot
 http://www.mayoclinic.org/diseases-
conditions/clubfoot/basics/

36. Thank
you