11.1 Club Foot and Developmental Dysplasia of the Hip (DDH)

Question 1

Talipes Equinovarus (Club Foot)

Answer 1

• Complex deformity of ankle and foot where foot turns inward/upward
• Associated with chromosomal abnormalities

What’s Happening?
- Forefoot Adduction
- Midfoot supination
- Hind foot Varus
- Ankle Equines

• Unknown cause but is associated with abnormal fetal positioning in the uterus
• Affected foot is usually smaller/shorter than unaffected foot
• Mild cases can resolve on their own but more moderate cases require casting

Question 2

Ponseti Method

Answer 2

• Progressive cereal casting used to correct Talipes Equinovarus before the child starts walking.
• Begins shortly after birth and lasts 3-6 weeks to reach full correction
• Casts are used to slowly move the child’s foot to the correct position
• ANYTIME CHILD IS IN A CAST MAKE SURE TO DO NEUROVASCULAR CHECKS, SKIN CHECKS, CIRCULATORY CHECKS.

Question 3

Genu Varum and Valgrum

Answer 3

Genu Varum - When kids legs are “bow legged”. The knees bow outwards

Genu Valgrum - Knock Kneed, the knees come inward.

Question 4

Hip Dysplasia (DDH) Developmental Dysplasia of The Hip

Answer 4

• Hip does not develop normally due to genetics, position in utero, and conditions during pregnancy. Typically seen from newborns.

Question 5

Acetabular Dysplasia

Answer 5

• Mildest form of DDH
• Osseous Hypoplasia of roof of acetabulum (Shallow sock and shallow femur at the hip joint)

Question 6

Subluxation and Dislocation

Answer 6

Subluxation (most common)
- Incomplete dislocation of hip (femoral head is partially outside of the hip socket)

Dislocation
- Femoral head loses contact with the acetabulum (hip socket)

Question 7

Hip Dysplasia Signs/Symptoms

Answer 7

Infants
- Asymmetry of Gluteal and Thigh Folds
- Limited Hip Abduction
- Shortening of Femur (1 leg might be shorter)
- Widening perineum

Children
- One leg shorter than other
- Walking on toes with one foot
- Walk with limp

Question 8

Testing for Developmental Dysplasia

Answer 8

• Done during newborn assessment

Ortolani Test
- Physician abducts thighs and place anterior pressure on the hip to see if the femoral head slips forward into the acetabulum

Barlow Test
- Physician adducts thighs and light pressure applied to see if femoral head can be felt to slip posterior out of acetabulum.

Question 9

DDH Treatment

Answer 9

PAVLIK HARNESS (0-6 months)
- If it occurs during infancy from 0-6 months they wear PAVLIK HARNESS for 6-12 weeks. They will need to go to clinic every 1-2 weeks to tighten straps
- Before Pavlik Harness is removed they must clear their exam and ultrasound.
- Harness progressively ABDUCTS the hip

SPICA CAST
- Worn for about 3-6 months

Nursing Interventions
- Skin care (make sure to keep diapers as dry and clean as possible. Also assess skin under the harness and cast)
- Massage healthy skin around the cast and diaper area to promote circulation
- DIAPER GOES UNDERNEATH THE STRAPS (to avoid moisture from diaper getting onto the cast)
- Neurovascular checks, skin checks, circulation checks, keeping diaper area dry and free of fluid when changing diapers.
- ALLOW SKIN TO AIR DRY
- Teach parents about proper skincare
- Think about what types of activities these kids can do in these casts (do not give children small toys that they can put inside their cast because that can create pressure underneath the cast). We still want to promote optimal development in turns of imagination and play.

Question 10

DDH Treatment Older Kids

Answer 10

Between 6-24 months
- Surgery or Spica cast for 12 weeks

Older than 24 months
- May have already adapted to the disease
- May receive preoperative traction, osteotomy, possible reconstruction of acetabular roof

Question 11

Nursing Diagnoses for Casts

Answer 11

• Casting is NOT a painful procedure
• Mobility impairment
• Skin integrity
• Alterations in Parenting