Club foot - Orthopedics

Question 1

Pathoanatomy of club foot?

Answer 1

б The components of deformity are: CAVE
1. Cavus
2. Adductus of the forefoot
3. Varus of the hind foot
4. Equinus of the ankle joint
б Contractures of the muscle and tendons in the medial aspect of the foot:
1. tibialis posterior,
2. flexor hallucis longus,
3. flexor digitorum and intrinsic muscles of the foot.
б Contractures of the ligaments and capsules of the ankle and foot joints
б Tight Achilles tendon.
б Bony changes:
1. Talar neck is medially and deviated planterly.
2. Calcaneus is in varus and rotated medially around talus.
3. Navicular and cuboid are displaced medially.

Question 2

Treatment of Club foot?

Answer 2

1. Nonoperative
   A. Ponseti method of serial manipulation and casting
2. Poَnseti method is the gold standard in most of the world
3. Goal is to rotate foot laterally around a fixed talus
4. Order of correction (CAVE)
   a. Cavus
   b. Adductus
   c. Varus
   d. Equinus
5. Achilles tendon tenotomy needed in at least 80% of children.
6. Outcomes:
   a. Ponseti method has a >90% success rate in avoiding comprehensive surgical release
   b. Children can be expected to walk, run and be fully active in the absence of other comorbidities.
   B. French method of daily physical therapy, manipulation, and splinting
7. Not commonly used.
8. Outcomes: good outcomes in skilled hands.
9. Operative treatment:
10. Posteromedial soft tissue release and tendon lengthening:
    » For resistant and relapsed cases.
    » Often performed in the 9th to 10th month so walking will not be delayed
11. Posteromedial release and tendon transfer:
    » For resistant and relapsed cases at age of 2-3 years
12. For older patients with resistant,
    » relapsed and rigid club foot bone operations can be done like:
    a. Medial column lengthening and lateral column shortening osteotomy
    c. Cuboid decancellation
    d. Talectomy in severe rigid cases.