How Common Is Clubfoot in Babies?

Congenital valgus foot is a common congenital foot deformity. It is a combination of three major deformities of foot drop, varus and adduction. Later, horseshoe, varus, and inversion, forefoot adduction, varus, and high arch are the major deformities. Males are more likely to develop unilateral or bilateral illness. The malformation is obvious and can be found at birth. Therefore, negligent cases are rare, and can be treated early and the effect is better. However, the malformation is also prone to recurrence. Regular follow-up should be performed until the bone is mature, about 14 years old. The cause is unknown. Congenital valgus foot has no special medical treatment.

Basic Information

English name

congenital talipes equinovarus

Visiting department

orthopedics

Multiple groups

male

Common locations

foot

Common causes

Primitive endosperm defects in the talus cause persistent talar flexion and varus and secondary soft tissue changes such as multiple joints and muscle tendons

Common symptoms

Horseshoe, eversion, inversion, forefoot adduction, eversion, high arch

Causes of congenital valgus

Regarding the etiology of varus varus foot, several theories have been proposed. One theory is that the primordial endosperm defect in the talus causes the talus to undergo persistent plantar flexion and varus, and is accompanied by multiple soft tissue changes such as joints and muscle tendons. Another theory is that primary soft tissue abnormalities in multiple neuromuscular units cause secondary bone changes. In clinically, children suffering from varus varus foot, in addition to atrophic calf triceps, also have anterior tibial artery dysplasia. Studies have shown that horseshoe varus type I and type II muscle fibers are abnormally distributed. The length and width of the affected foot may be 0.75cm to 1.5cm shorter than normal feet.

Clinical manifestations of congenital valgus foot

Because foot deformities can be seen immediately after birth, diagnosis is usually not difficult. Congenital horseshoe varus can generally be divided into rigid type (internal cause type) and soft type (external cause type).

Stiff type

Severe deformity. Ankle and subtalar joint plantar flexion deformity is obvious, talar plantar flexion, the prominent talar head can be felt from the dorsal side of the foot. Because the back of the calcaneus is upturned and hidden behind the lower end of the tibia, the heel seems to become smaller, and at first glance it looks like a rod without a heel. Achilles tendon contracture is severe. Viewed from the rear, the calcaneus is inversion. The forefoot also has an adduction and varus. The scaphoid is located deep inside the foot, close to the talus head. The sacrum protrudes to the outside of the foot. Thin. This deformity is stiff and fixed when passive dorsi valgus, and this deformity is not easy to correct. The child has difficulty standing, postponed walking, limp, and can support the lateral load of the foot or the back of the foot when supporting. Slightly older, with lameness, stiff soft tissues and joints, small feet, thin legs, and obvious muscle atrophy, but feel normal. After long-term weight-bearing, thickened bursa and palate can appear on the outside of the back of the foot, and a few ulcers occur. Patients often have other deformities at the same time.

2. Soft type

The deformity is lighter, the heel size is close to normal, mild skin wrinkles on the ankle and the outside of the back of the foot, and the calf muscle atrophy is not obvious. The biggest feature is that it can correct horseshoe varus deformity during passive dorsiflexion, which can make the affected foot reach or approach the neutral position, easy to correct, easy to cure, difficult to relapse, and good prognosis. This type is caused by abnormal intrauterine position.

Congenital horseshoe foot check

Diagnosis can be made based on clinical manifestations, and diagnosis is generally not required based on X-ray examination. However, X-rays are indispensable for judging the degree of deformity of the horseshoe and the objective evaluation of the therapeutic effect. Normal neonatal foot X-rays show the ossification centers of the heel, talus, and sacrum. The ossification center of foot bones of children with valgus foot appeared later. The scaphoid did not appear until the age of three. The metatarsal bone is well ossified after birth.

Orthophoto

There is an angle of about 30 ° between the normal longitudinal axis of the talus and the longitudinal axis of the calcaneus. If it is less than 20 °, the posterior foot is turned inward. Normal foot 1st metatarsal and talus longitudinal axis, 5th metatarsal and calcaneal longitudinal axis parallel or cross angle is less than 20 °, greater than 20 °, anterior adduction of the foot.

2. Side view film

The normal talus longitudinal axis is parallel to the 1st metatarsal, and patients with valgus foot in horseshoes intersect at an angle.

Diagnosis of congenital valgus

1. After the baby is born, there will be one or two foot plantar flexion and varus deformities.

2. Forefoot adduction and varus, talar plantar flexion, calcaneal varus and plantar flexion, Achilles tendon, plantar fascia contracture. The forefoot becomes wider, the heel becomes narrow and the arch is high. The lateral malleolus protrudes forward and the medial malleolus is posterior and inconspicuous.

3. When standing and walking, carry weight on the outer edge of the iliac crest. In severe cases, load on the outer edge of the dorsum of the foot.

4. Unilateral deformity, lame walking, bilateral deformity, walking sway.

5. X-ray film shows that the talus and the longitudinal axis of the first metatarsal cross at an angle greater than 15 °, and the angle between the calcaneus metatarsal plane and the longitudinal axis of the talus is less than 30 °.

Differential diagnosis of congenital valgus

1. Neonatal foot varus

Neonatal foot varus is similar to congenital horseshoe foot in appearance, most of which are on one side. The foot is horseshoe varus but the inside of the foot is not tight. The foot can be stretched back to touch the front of the tibia. It can be completely normal by manual treatment for 1 to 2 months.

2. Neurogenic horseshoe foot

The horseshoe foot caused by neural changes gradually becomes obvious with the developmental deformity of children. Pay attention to whether the intestinal and bladder functions are changed, whether there is a numb area on the outside of the foot, and pay special attention to the lumbosacral concavity or the pigmentation of the sinus and the skin. If necessary, MRI should be performed to determine the presence of tethered spinal cord. Electromyography and nerve conduction tests are helpful in understanding nerve damage.

3. Horseshoe foot after polio

There were no deformities in the appearance of the foot at birth, and the age of onset was more than 6 months. He had a history of fever, more common on one side, and paralysis of the long and short peroneus fibula. There was no fixed deformity in the early stage, normal stool and other muscle paralysis.

4. Horseshoe foot after cerebral palsy

There is a history of hypoxia in the perinatal period or after birth, and most of them are abnormal after birth. Horseshoe foot deformities gradually become apparent with growth, but they can disappear or reduce during sleep, and the deformities are more obvious upon stimulation. Horseshoe-based, less varus, no adduction, malformations mostly bilateral or ipsilateral upper and lower limbs, cross-gait of both lower limbs, lower limb muscle spasm is obvious, often accompanied by mental retardation.

5. Polyarthrosis

Horseshoe foot is bilateral, foot deformity is part of multiple joint deformities in the whole body, most of the muscles in the whole body atrophy and harden, fat is relatively increased, horseshoe foot stiffness is difficult to correct, and hip and knee joints are often involved.

Part of multiple joint deformities throughout the body, most of the muscles in the body are atrophic and hardened, fat is relatively increased, and horseshoe foot stiffness is difficult to correct, and the hip and knee joints are often affected.

Congenital horseshoe foot treatment

Congenital valgus feet should be treated according to the age and deformity of the child.

1. Early non-surgical treatment

(1) Ponseti orthopedic method: it has been affirmed by the whole world. The specific treatment method is as follows:

1) Manual massage and gypsum fixation (Ponseti gypsum fixation): suitable for children under 1 year of age, the deformed components are corrected one by one according to a certain procedure, and then fixed with gypsum casts (usually 4-6 outpatient fixation).

2) Achilles tendon release: Achilles tendon release can be performed when the plaster fixation reaches more than 75 degrees of foot abduction. The plaster is fixed for 3 weeks after the operation, the plaster is removed after 3 weeks, and the orthopedic shoes are replaced at the same time.

3) Orthopedic shoe treatment: Dennis-Brown orthopedic shoes are used for further treatment after surgery, usually to 4 years old.

(2) French massage technique: newborns should be treated by hand immediately, knees bent 90 degrees during operation, holding the heel with one hand, pushing the front half foot forward with the other, correcting forefoot adduction, and holding the heel for eversion Finally, Yi palm dragged the soles of the feet for back extension, corrected the horseshoe, and corrected it several times daily until the deformity was corrected.

2. Surgical treatment

For children who have missed the opportunity of non-surgical orthopedic surgery or children who have deformed recurrence due to failure to wear orthopedic braces in accordance with the doctor's order after the orthopaedics, corresponding symptomatic surgery should be performed according to their different situations.

(1) Extensive soft tissue release: Surgical methods include Turco, Mckay, Carroll and other methods, which are to release the soft tissue of the ankle contracture to restore the normal anatomical structure between the sacrum. The general principles of any phase of generalized loosening treatment for varus varus include:

1) When the operation is completed, loosen the tourniquet and electrocoagulate to stop bleeding;

2) When necessary, keep the foot in the plantar flexion position and carefully suture the subcutaneous tissue and skin to avoid excessive skin tension;

3) When the plaster is changed for the first time 2 weeks after surgery, the foot can be placed in a fully corrected position.

(2) Achilles tendon extension: For children who have missed the age of Achilles tendon release (usually 2 to 3 years old), they need to release the Achilles tendon, so that the Achilles tendon is extended, and the Achilles tendon is Z-shaped. Cut open. Postoperative plaster fixation for 6 weeks.

(3) Tibialis anterior abduction: Applicable to children with mild recurrence of horseshoe foot in early stage, or residual forefoot adduction deformity after treatment.

(4) External fixation bracket: For older children with stiff horseshoe varus (usually over 5 years old), the bones of the foot have been ossified, and the deformity cannot be corrected by soft tissue alone. External fixation technology can be used, and regular adjustment is required after surgery. The stent is basically satisfactory in appearance, but it will leave stiff ankle joints.

(5) Foot osteotomy: There are many surgical methods. Generally, children are older than 5 years old. According to their deformity, different parts of the osteotomy can be selected, which can be combined with external fixation bracket to correct horseshoe varus deformity.

(6) Three-joint fusion: indications for children over 10 years of age; combined with three deformities of sacral adduction, hindfoot inversion, plantar flexion; this operation can be considered.

Surgical treatment should take into account the development and growth factors of the limb. Surgical correction can be performed in stages, and the damage should not be too great.