Clubfoot Flashcards
What is clubfoot?
4 components – midfoot cavus, forefoot adductus, heel/hindfoot varus and hindfoot equinus
Usually tarsal bones flexed and adducted, talus medially deviated and plantarflexed
How much is bilateral?
2/3
How much is isolated?
2/3; 1/3 with complex anomalies
What are risk factors for clubfoot?
multifactorial-disrupted neuromuscular unit and unopposed muscle activity restricting the ankle in a distorted position
What causes clubfooting?
Genetics 25% familial, unclear, environmental – smoking, diabetes, in utero positioning, Hawaiian ethnicity
What conditions are associated with clubfoot?
ONTD (caudal regression, myelomeningocele), NMD (akinesia sequence, myotonic dystrophy, distal arthrogryposis), Aneuploidy(T18/13/sex), genetic syndromes, myelomeningocele, amniotic and sequence, CV/GU/GI/facial, 4% born with polydactyly, hypospadias and hip dislocation, Genetic – Trisomy 18, Chromosome 22q11 deletion syndrome
What is the likelihood of anomaly with clubfoot?
33%
Ddx for clubfoot?
rocker-bottom foot, arthrogryposis, skeletal dysplasia, amniotic band sequence, ectrodactyly
How do you stage clubfoot?
Pirani system – measures 6 parameters in the foot
US features of clubfoot
tib/fib in coronal plane with sole all in same plane; varus foot; FP rate 30%
short angulated foot on plantar foot view, sag view shows pointed toes
How do you manage clubfoot?
GC - Amnio, +/- Echo, follow-up US, prenatal pediatric ortho referral
How do you treat clubfoot?
Splint/cast (Ponseti) - serial casting of foot and maintenance of correction – cast for 5-7 days, up to 5-9 causes using plaster of paris, 98% correction rate
40% tendon release surgery (Achilles tenotomy)
