Congenital clubfoot is a common congenital foot deformity. There are many diseases in men, which can be unilateral or bilateral. Deformities are obvious and can be found at birth, so there are few cases of negligence. Most of them can be treated as early as possible, and the effect is good. However, deformities are easy to recur, so they should be followed up regularly until the bones are mature, about 14 years old.
Congenital clubfoot, unilateral or bilateral entropion ptosis in different degrees after birth. In light cases, the forefoot is adducted and drooped, the plantar surface is shrunk, and the dorsal extension and abduction have elastic resistance. After the child learns to walk, the deformity is gradually aggravated, the balance of muscle strength between the foot and calf is unbalanced, and the healthy muscles contract. In addition, due to the influence of weight, the medial part of the foot is aggravated, the gait is unstable, limping, and the lateral edge of the dorsum of the foot touches the ground, which makes the deformity more serious.
Etiology of congenital clubfoot
1, genetic factors:
This disease often has a family history and has a certain relationship with heredity. For example, Wynne-Pavis reported that the proportion of patients with family history was 2.9%; In addition, the incidence of identical twins is high, with a ratio of 33:3. Although heredity is an important factor, the genetic law of dominant, recessive or sex-linked genes is still uncertain.
2. Embryonic factors:
Within 3 months, the foot is in three original deformation states of horseshoe varus, namely drooping, adduction and supination. From the fourth month, the foot is in a neutral rotation position, the metatarsal bone is slightly adducted, and the foot begins to pronate along the long axis, which is close to the position of the normal foot. Any developmental disorder will keep the foot in a deformed position in the early embryo.
3. Intrauterine factors:
The position of the fetus in the uterus is not good, the foot is compressed, and it is in the position of foot adduction, heel inversion and ankle drooping for a long time. Therefore, the muscles of the posterior and medial sides of the calf are shortened, and the medial joint capsule is thickened, thus further deforming the foot.
4. Environmental factors:
Many scholars have found that this disease is related to environmental factors. For example, Duraswami injected insulin into developing chicken embryos, resulting in deformed feet.
What are the symptoms of congenital clubfoot
1, rigid type
Severe deformity. The plantar flexion deformity of ankle joint and subtalar joint is obvious, and the talus is plantar flexion, and the prominent talus can be felt from the dorsal skin of the foot. Because the rear end of the calcaneus is hidden behind the lower end of the tibia, the heel looks relatively small. At first glance, it seems to be a rod-shaped foot without a heel, so it is also called a rod-shaped foot. Achilles tendon contracture is serious. Seen from the back, the calcaneus is inverted. The forefoot also has adduction and varus. The navicular bone is located in the deep part of the medial foot, close to the talus. The cuboid bone protrudes to the lateral foot, the medial foot is depressed, the dermatoglyphics of the medial ankle and heel are increased, and the skin of the lateral foot and dorsum of the foot is tightened and thinned. Passive dorsiflexion valgus is rigid and difficult to correct. Children have difficulty standing, walking slowly and limping. When standing, they can see the load on the outside or back of their feet. Older, limping obviously, stiff soft tissue joints, small feet, thin calves, obvious muscle atrophy, but feeling normal. After long-term load-bearing, thickened synovial sac and callus can appear on the lateral dorsum of the foot, and a few ulcers appear. Patients often suffer from other deformities at the same time.
2. Soft type
The deformity is slight, the heel size is close to normal, there are slight skin wrinkles on the lateral ankle and instep, and the calf muscle atrophy and thinning are not obvious. The biggest feature is that it can correct its clubfoot deformity when it is passively dorsiflexion and eversion, which can make the affected foot reach or approach neutral position, which is easy to correct, the curative effect is easy to consolidate, it is not easy to relapse and the prognosis is good. This type is caused by abnormal position in uterus.
The best treatment opportunity for congenital clubfoot.
Babies with horseshoe feet should be treated at 1-2 weeks after birth. At this time, the tissue elasticity of ligaments, joint capsules and tendons is good, which is beneficial to treatment. Manipulation once a week, gently stretching these tissues, and then sticking them, keeping the angle of traction correction and softening ligaments; At the same time, the displaced bones gradually returned to the normal arrangement position.
How to treat congenital clubfoot?