case 26: clubfoot Flashcards
What is a foot abduction brace?
straight laced shoes or boots connected via an attachment to a bar, allowing LEs to be held in up to 70 degrees of hip ER as well as 10 degrees of ankle DF
What is idiopathic clubfoot?
equinovarus foot deformity apparent at birth with no associated underlying diagnosis.
*hindfoot PF, forefoot adduction
What is the ponseti method?
Ponseti: intervention for clubfoot correction
serial casting technique to realign talus in TC joint.
after several above knee casts, percutaneous tendo Achilles lengthening procedure is performed.
After surgical realignment of the foot, kid wears cast for 3 weeks, then a foot abduction brace.
Initially, child wears brace 23 hours/day for 3 months.
Gradually reduce wear to 10-12 hours/day, up to age 5 years old
What is relapsed clubfoot?
clubfoot that was corrected but tightened through growth/change and can no longer get neutral alignment
What are signs and symptoms of clubfoot?
-foot has high longitudinal arch associated w/ plantar flexed first ray, bean-shaped curved appearance with inability to correct forefoot to neutral from adducted posture, and varus hindfoot that cannot be passively DF to neutral
-hard time with squatting (early heel rise, weight shift onto uninvolved side)
-standing: flatfoot, genu recurvatum
-gait: intoeing in stance phase
What are valid and reliable outcome measures to assess mm strength and endurance in kids with clubfoot?
- Observational Gait Scale
- measure forefoot abd and add in supine/sitting
- Thomas test, SLR, or 90-90 (popliteal angle) for muscle asymmetries up the chain
PDMS-2 for kids 0-5
What are some precautions during PT for kids with clubfoot? What is a complication that could interfere with PT?
Precautions:
1. stress fracture prevention after serial casting
2. avoid high impact activities (running, jumping, hopping)
3. identify and prevent compensatory strategies during high level balance/WB activities
Complication: stress fractures
What is the foot position of someone with with idiopathic clubfoot?
aka equinovarus foot deformity
talus rotated medially on calcaneus: short medial longitudinal arch, long lateral column of the foot
What mm are short and what mm are long in clubfoot?
long: fibularis muscles: biomechanical disadvantage
short: medial muscles (first ray is PF and retracted)
How long should child wear a foot abduction brace after initial correction with Ponseti method?
up to 5 years!
What is the first indication of clubfoot relapse?
TOE IN during stance of gait
(then later, early heel rise after initial contact, and eventually, no heel strike w/ initial contact)
Will a child with clubfoot be able to squat well?
no! secondary complications due to hip and knee weakness later
Which of the following best describes the anatomic position of a clubfoot that is not completely corrected?
A. elongated and plantarflexed first ray with DF beyond 10 degrees
B. prominent base of the fifth metatarsal on palpation
C. forefoot abduction beyond neutral and ability to squat with feet flat on floor
D. retracted and PF first ray, forefoot adduction that does not correct past neutral, and prominent base of the fifth met on palpation
D: tight structures along medial aspect of foot –> great toe shortened through PF of first ray –> forefoot adducted
lateral column elongated, so base of fifth met (pinky toe) is visibly prominent
hindfoot is tight, resulting in inability to keep flat foot on floor when squatting
What is a common gait pattern with relapsing clubfoot?
early heel rise after initial contact with intoeing during stance phase
What would be an appropriate activity for a PT to give a child with clubfeet as HEP?
A. pick up marble with toes
B: balance on one foot
C. heel raises
D. stand on slant board with heels down, knees in hyperextension
B: balance on one foot
_____is associated with recurrence of clubfoot deformity
NONCOMPLIANCE OF BRACE WEARING
What are 4 common functional outcome measures used by PTs for people with clubfoot?
- 10 minute walk test
- 2 minute walk test
- TUG
- single limb stance test (balance on one foot)
