CASE 26- Relapsed Clubfoot Flashcards
Foot abduction brace
Straight-laced shoes or boots connected via an attachment of a bar, allowing the lower extremities to be held in up to 70 degree of hip external rotation as well as 10 degree of ankle DF
Idiopathic Club foot
Foot deformity apparent at birth with no associated underlying diagnosis; foot has a high longitudinal arch associated with plantar flexed first ray, bean-shaped curved appearance with inability to correct forefoot to neutral from its adducted posture, and varus hind foot that cannot be passively DF to neutral
Ponseti Method
Intervention for club foot correction method involving a specific serial casting technique to realign the talus in the talocrural joint after several above-knee casts, a percutaneous tendo- Achilles lengthening procedure is performed to achieve full correction of the foot. After surgical realignment of the foot, the joint is casted for 3 weeks and then the child wears a brace 23 hours per day for 3 months and then gradually reduces wear to 10-12 hours per day, up to age of 5
relapsed clubfoot
Clubfoot that has previously been corrected ( allowing forefoot abduction and hind foot DF past neutral ), but has tightened through growth and change and can no longer achieve a neutral alignment
General PT plan of care/ goals
Improve ROM
Improve great toe extension while the first ray is held in neutral DF
Improve balance and strength
Improve gait pattern
Identify the risk of clubfoot relapse
Identify and address gross motor defects as compared to age-matched peers
PT interventions
Patient/family education regarding club feet and the risk of joint contracture development and asymmetrical muscle strength
monitor progress with valid and objective measures
therapeutic exercises to address muscular tightness and weakness
home exercise program instruction
Precaution during PT interventions
Stress fracture prevention after serial casting
avoidance of high Impact activities such as running, jumping, and hopping
identify and prevent compensatory strategies during high level balance and weight-bearing activities
Complications interfering with PT
Stress fracture
what are the four functional measures used to assess function in children with clubfoot?
10-meter walk test
2 min walk test
TUG
Single limb stance Test
sample exercises for club foot
-midfoot mobilization
-stretch medial column of foot
-stretch hind foot into Df
-Stretch great to into extension
-holding contraction at end rage of DF
-holding contraction at end range eversion
-resistive strengthening ankle DF and EV
-hamstring stretch standing balance on one foot
-stair ambulation
-elliptical trainer
- squat with hand over for support to maintain foot flat
noncompliance with wearing the abduction foot brace is closely associated with recurrence of clubfoot deformity
grade B: inconsistent or limited-quality patient-oriented evidence
the first indication of clubfoot relapse is increased in-toeing during stance phase of gait
grade A: consistent, good quality patient oriented evidence
the french PT method that includes daily stretching of shortened tissues, stimulation and strengthening of weakened muscles, taping and splinting, and closed chain training can be used to help support optimal alignment of the clubfoot
Grade C
which of the following BEST describe the anatomic position of clubfoot that is not completely corrected
retracted and plantar flexed first ray, forefoot adduction that does not correct past neutral, and a prominent base of the fifth metatarsal on palaption
a relapsed clubfoot has tightening of the structure along the —-
medial aspect of the foot, resulting in the great toe being shortened through PF on the first ray
with the tight medial structure—
it is hard to stretch the medial column of the foot beyond neutral forefoot abduction
as a result of tight medial structure—-
the lateral column of the foot is elongated with the base of the 5th metatarsal being visibility prominent
what is the result of the hindfoot becoming tight
inability to keep feet flat on the floor when attempting to squat
which of the following is a common gait pattern with relapsing clubfoot?
Early heel rise after initial contact with in-toeing during stance phase ( internally rotated supinated foot)
what is not a typical gait pattern that is present with clubfoot?
steppage gait pattern
which of the following would be an appropriate activity for the PT to give a child with Clubfeet as a home program?
balancing on one foot- encourage foot flat with control
what exercise would not be appropriate for a child with clubfoot?
-marble pick up with toes
-heel raises
- standing on slant board with heels down and knees hyperextended
