What is Clubfoot (Pes Ekinovarus)? How is the treatment done?
Index
What is Clubfoot (Pes Ekinovarus)?
What are the Symptoms of Clubfoot (Pes Echinovarus)?
What are the Causes of Clubfoot (Pes Echinovarus)?
Clubfoot (Pes Ekinovarus) What Are the Types of Diseases?
How is Clubfoot (Pes Echinovarus) Diagnosed?
What are the Treatment Methods for Clubfoot (Pes Ekinovarus)?
How Long Does Clubfoot (Pes Ekinovarus) Treatment Take?
Club foot, one of the most common congenital anomalies, is a congenital anomaly in which one or both feet are turned inwards. Popularly known as clubfoot or clubfoot, this condition is called pes equinovarus (PEV) in the medical literature. Clubfoot deformity, which is one of the most common congenital anomalies, is mostly idiopathic.
What is Clubfoot (Pes Ekinovarus)?
Clubfoot, with its general definition, is a congenital defect characterized by the shape and function of the newborn baby’s foot unilaterally or bilaterally. It is a condition that occurs approximately once in every 1000 births. The affected toe has turned inwards and downwards from the ankle, and the arch of the sole of the foot has increased. The toes and heel are bent forward as if trying to catch something. Depending on the deformity, although the foot has different forms of severity, it sometimes rotates so violently that the foot is as if it is standing upside down. Even if you try to bring the foot to its normal position with your hand, you will not succeed. This condition, which can be on one or both sides, sometimes with different congenital anomalies, will result in very serious gait and visual impairment if not treated. It is not a situation that can be left to itself and expected to improve. It has been seen in the records since the time of Hippocrates that he was treated with wax-like plasters and that pictures of this disease were drawn in ancient Egyptian records. It is known that some successful football players, ice skating athletes and film actors have mild forms of this ailment during infancy, although they are few in number today.
What are the Symptoms of Clubfoot (Pes Echinovarus)?
During pregnancy, this condition can be detected between 18 and 21 weeks of pregnancy by ultrasonography performed on the mother. It manifests itself physically with deformity immediately after birth. Some anomalies such as congenital hip dislocation and spina bifida (usually in the lumbar region, behind the spinal cord, in the formation of the bone structure) may accompany clubfoot. While the disease affects one foot in half of the cases, it affects both feet in the other half. In unilateral foot involvement, it is seen slightly more frequently in the right foot than the left foot. The affected foot is slightly smaller and less mobile than the other. The folds and lines in the skin structure on the back and sole of the feet have an unusual appearance. The calf muscles on the side of the patient’s foot are generally less developed. No matter how bad the deformation image in the foot is for a newborn baby, the baby will not feel any pain from it yet; because he is used to this position. Complaints will appear when he tries to stand up or starts to step. These babies try to walk by stepping on the outside of their feet or on the back of their feet. If it is still not intervened, calluses in the outer side of the foot, deformities in the foot joints, arthritis and progressive deformities occur. For this reason, treatment options should be started by a pediatric orthopedic specialist, if possible, from the first weeks.
What are the Causes of Clubfoot (Pes Echinovarus)?
The majority of pes equinovarus deformity is idiopathic, meaning the cause cannot be determined. According to some statistical studies, some of the features determined that clubfoot deformity may have a genetic basis are as follows:
It has been found that it is more than twice as common in boys than girls.
Although genetically monozygotic, i.e. identical twins, share the same genome, only one-third will have both babies. In fraternal twins, this rate is even lower.
Chromosomal disorders such as trisomy 18
Presence of this disease in first-degree relatives
Situations where the amniotic fluid in which the baby swims during pregnancy is low,
Early in pregnancy, 11-12. amniocentesis in weeks,
The mother’s use of substances such as cigarettes, alcohol or drugs during pregnancy,
In some countries, the Zika virus, which can be transmitted to the baby during pregnancy by mosquitoes, is among the risks that increase the disease.
Again, some of the theories put forward about the development of the disease include:
The inability of the feet to move sufficiently in the uterus due to reasons such as spina bifida, disorders affecting the neuromuscular structure, and lack of amniotic fluid.
Abnormal fibrosis and shortness of tendons and muscle fibers found in the feet
Developmental anomalies in foot bones and joints
Disorders of the branches of the anterior tibial artery feeding the feet
Clubfoot (Pes Ekinovarus) What Are the Types of Diseases?
Clubfoot is classified according to the direction and angle of bending in the feet. The directions of the flexion of the ankle and forefoot can be together or singular. The front part of the foot can turn inward or outward with the sole or just angularly. According to the ankle joint, there are forms in which the foot is bent upwards and backwards, that is, approaching the tibia bone (front of the leg), as well as bending the foot downwards away from the tibia. The most common form is the type called talipes equinovarus, in which the foot bends down and inward, and the toes bend towards the sole of the foot. Generally, babies born this way do not have any additional disease, only the feet are affected.
the severity of the disease,
Softness and hardness in the bending of the foot,
Whether there is another anomaly accompanying the clubfoot,
It is evaluated according to the involvement of one or both feet.
How is Clubfoot (Pes Echinovarus) Diagnosed?
The diagnosis of clubfoot can be made by ultrasound during pregnancy, or it can be noticed immediately after birth. Because the baby’s feet have a typical appearance and stance with the above-mentioned features that can also be noticed from the outside. Physical examination is performed especially by pediatric orthopedists for a clear diagnosis and measurement of the extent of the disease. Then, the feet can also be examined by imaging with radiological methods. Differential diagnosis is necessary because it can be confused with some deformities with similar physical appearance. Conditions that club foot deformity can often be confused with include:
Compression for the uterus
trauma during childbirth
Absence of tibia bone
When the differential diagnosis is made and it is understood that there is no foot deformity due to another disease, a definitive diagnosis can be made. While foot flexion resulting from intrauterine compression and birth trauma can be easily corrected with the intervention of a doctor, unfortunately, such treatment is not possible in crooked feet.
What are the Treatment Methods for Clubfoot (Pes Ekinovarus)?
Treatment for pes equinovarus should be started within the first week after birth. Improvements in foot posture at each step of treatment should be recorded with photographs and, if necessary, x-rays for correct casting positions.
There are two approaches known in this regard, namely the Ponseti method and the French method:
Ponseti method: After the baby’s foot is brought to some physiological position, it is placed in a cast of appropriate softness. Every week, this plaster is removed and replaced with a new one, giving the foot a more suitable posture. This is repeated every week for about 2 months. Sometimes, in order to increase the success of this non-surgical treatment, after the last plaster is removed, it is necessary to lengthen the strongest tendon of the body, which we call Achilles, which holds the heel of the foot and the calf, under local anesthesia, in order to keep the ankle freer and to bend towards the back of the foot easily. Afterwards, the foot, which is placed in the most suitable position, is cast again in order for the Achilles tendon to heal and the foot to stay in its proper position. In each casting period, whether the blood circulation is impaired, foot temperature, color and movements of the fingers are checked.
French method: Not very flexible tapes and splints are used instead of plaster. In the company of the physiotherapist, the family is trained and the foot is tried to be brought to the appropriate functional position as soon as possible. It is an alternative for families with restless babies who do not want to use plaster.
In both treatment procedures, if clubfoot is not corrected, orthopedic surgeons will try to bring the bone and joint structures of the foot into the most appropriate form. In general, operations for clubfoot are performed between 6 months and 1 year of age. The foot is kept elevated for a while after the operation to prevent swelling or edema. There are specially designed boots (foot abduction orthoses) that should be worn continuously during the day for the first 3 months after the operation, and then only while sleeping until the age of 4-5. These boots are attached to each other at a certain distance and from the base with a metal bar. And as long as the boots are worn, they will try to provide the most physiological and appropriate posture to the feet. Even when the patient is awake without wearing this orthosis, stretching exercises that will make the foot more functional should be performed as determined by physiotherapists. It should also be noted that shape correction surgery of the foot may have some short and long-term side effects of its own. Recent infection, bleeding and nerve damage around the incision site; In the distant period, stiffness in the foot joints, limitation of movement and arthritis can be observed, although rarely.
How Long Does Clubfoot (Pes Ekinovarus) Treatment Take?
Depending on the severity of the disease, in mild cases, it can be corrected to a large extent within a period of 3 months by giving the foot a correct posture with plastering, stable tape, splints and physiotherapy, such as the Ponseti or French method. The child can catch up with his peers in walking and wear the same shoes as them. However, since there is a possibility of recurrence of the disease, these treatments should still be continued until the age of 3-4 years. There are also opinions that argue that this period should be kept longer as a precautionary measure.
In severe cases requiring surgery, surgery is usually performed when the baby is 6 months old or 1 year old. Afterwards, it may require the use of special boots or splints at certain times of the day until the age of 3-4. Unfortunately, in some cases, disease sequelae such as gait and foot deformity, shortness of the foot or smallness of the feet, which continue in advanced ages, may occur despite treatment. These patients may have to use tools and devices to walk comfortably.
If the treatment of the disease is not followed, especially during infancy and childhood, it is unfortunately possible for the disease to relapse and return. If you observe such a foot stance in your family or in your environment, you can start your diagnosis and treatment process by applying to a health institution near you.