Clubfoot in a child: causes, symptoms, correction at home

Clubfoot in children (congenital equinovarus deformation of the feet) is one of the most common congenital skeletal deformities affecting the feet. Occurs with a frequency of 1:250-1:1000 depending on the population. More common among boys. 1/2 cases with bilateral lesions. Genetic predisposition is determined, so if one of the children had congenital clubfoot, the chance that another child will be born with the same disease is 2.5-6.5%. Congenital clubfoot may be accompanied by other congenital defects: hand anomalies, arthrogryposis, hemimelia, myelodysplasia and many others.

The pathogenetic mechanism of clubfoot is a difference in the tone of several muscle groups, which leads to muscle contracture on the one hand and their hyperextension and weakness on the other.

1) Cavus deformity of the midfoot (due to contracture of the intrinsic muscles of the foot, flexor hallucis longus and flexor toes longus)

2) Adductor deformity of the forefoot (contracture of the tibialis posterior muscle).

3) Varus deformity of the hindfoot (contracture of the gastrocnemius muscle, tibialis posterior muscle, tibialis anterior muscle)

4) Equinus deformity of the hindfoot (contracture of the gastrocnemius muscle)

Symptoms of clubfoot.

-The small size of the foot and lower leg is determined.

-Shortening of the tibia.

-A skin fold is determined along the posteromedial surface of the foot.

-Equino-cavo-varus-adduction deformity of the foot.

Clubfoot clinical diagnosis. When performing radiographs, a reduced (less than 35°) talocalcaneal angle is determined in the lateral projection in the dorsiflexion position. In the anteroposterior projection, the talocalcaneal angle is also reduced (less than 20°).

About the disease

The medical name is equinovarus deformity.
The frequency is about 3 cases per 1000 newborns. The bilateral variant is more common, and among boys the incidence is 2 times higher. The disease can be combined with other developmental anomalies - torticollis, congenital hip dislocation, scoliosis. Unilateral clubfoot makes one leg shorter than the other. The following degrees of severity are distinguished:

• easy – movements in the ankle joint are possible in full;
• medium – movements in the joint are somewhat limited; when trying to straighten the position, an obstacle and springiness are felt;
• severe - the bones and ankle joint are deformed, it is impossible to return the foot to its place using manual correction methods.

A severe degree is accompanied by dysfunction of the muscles and nerves of the leg; there may be other developmental anomalies.
Up to 4 months, some clubfoot is considered normal. The baby is just learning to walk, and the body gains greater stability when the toes are turned inward. This makes it more comfortable for the knee and hip joints. As the child grows, this clubfoot goes away. However, in all doubtful cases, it is better to consult a pediatric orthopedist-traumatologist.

Symptoms of congenital clubfoot

Clubfoot is visible even at birth: the bent foot is turned with the sole inward and upward, movements in the ankle joint are limited.
If the child is already walking, he rests only on the outer edge of the foot. The baby steps over the leg on which he leans. The gait is swaying and uneven. Without treatment, bone deformation worsens, and subluxations occur in the small joints of the foot. The outer edge of the skin of the foot becomes rough. The lower leg muscles that are not involved in the walking process gradually weaken and atrophy. As a result, the function of the knee joints and pelvic joints is impaired. The later treatment is started, the more severe the disorders and the harder they are to correct. General features are the same for all degrees:

• plantar flexion is visible in the ankle joint;
• the sole is turned inward, the outer edge hangs;
• the forefoot is adducted inward;
• the lower leg muscles are poorly developed and atrophied in older children;
• a waddling gait is noted;
• with a unilateral lesion, one leg is several centimeters shorter than the other.

When walking or standing, children quickly get tired, rub their skin, and complain of nagging pain in their legs.

How to correct pathology at home

Treatment of a mild form of the disease can be carried out at home, subject to constant monitoring by an orthopedist. The doctor prescribes complex procedures.

Gymnastic exercises

At first, a specialist performs therapeutic manipulations on a newborn in the presence of the mother. Then you can repeat them at home, taking into account some points:

1. It is necessary to work with each foot for at least 7 minutes with the frequency of approaches 10 times.
2. In this case, it is necessary to carefully correct the baby’s behavior so that during the procedure he does not turn his legs inward.
3. The muscles are warmed up with massage movements.
4. Bend and straighten your legs at the knees.

We told you how to correct (treat) clubfoot in a child under 2 years old, because curing after 5-6 years is much more difficult.

This will require the following exercises:

1. Make circular movements with your feet.
2. Walk on heels and squatting.
3. Raise your legs 90 degrees.
4. Draw with a stick or pencil held between the thumb and second finger.
5. Pick up a towel from the floor.
6. Stretch the spine using a horizontal bar.
7. At an older age, it is very effective to skateboard and ride a horse.

Massage

The procedure should be performed by a specialist who knows the anatomical features of the skeleton, because types of massage involve relaxing the muscles or, conversely, giving them tone.

In this case, the medical worker uses such hand movements (if a newborn or one year old child is clubbing) as: stroking, tapping, light pressure, pinching.

To avoid complications in the future, it is necessary to start treatment as early as possible. After all, parental neglect and inaction can lead to serious illnesses:

1. rachiocampsis;
2. sleep disturbance
3. atrophy of the ankle muscles;
4. improper development of the hip and knee joints;
5. disruption of the functioning of internal organs due to their displacement;
6. retardation in mental and physical development.

Therefore, a comprehensive adjustment is necessary using massage, gymnastic exercises, orthopedic shoes and rigidly securing the leg with a removable “Brace” device.

Unilateral clubfoot in a child under 5 years of age

If problems are identified with one leg, then parents should seriously think about it, because if treated incorrectly, such a pathology develops quickly and spreads to the second foot within one year. Therefore, the orthopedist prescribes a full examination of the hip joints using ultrasound and the brain (if a neurotic disease is suspected).

If the cause of the development of the disease is a problem with a lack of vitamin D, then a diet is prescribed where the diet contains foods high in calcium. Appropriate medications are also prescribed.

It is strictly contraindicated for infants to be in jumpers and walkers. Older children are prescribed massage and exercises. One of the most effective activities is walking with the Charlie Chaplin gait. You can draw a stylized Christmas tree on the asphalt or on the floor in your apartment. Make sure that the baby steps on the branches, while turning the toes of his feet outward.

We provide you with a visual aid by which you can find out what clubfoot is in a 1-2 year old child, why he clubfoots when walking, what to do, and what treatment is prescribed for children.

Causes of congenital clubfoot

It is not always possible to establish the exact cause in each specific case. The most common are the following:

• the impact of adverse factors on the mother’s body in the first trimester, when the formation of the lower extremities occurs;
• maternal addictions - smoking, drinking alcohol and drugs;
• pressure (mechanical) of the umbilical cord or fetal sac on the foot;
• a small amount of amniotic fluid, in which the uterus presses on the legs of the fetus;
• congenital pathology of the spinal cord or peripheral nerves;
• uncontrolled use of medications in high doses;
• some infections;
• uterine tumors.

The fetus is most vulnerable in the first trimester. Damage suffered during this period is extremely difficult to repair later. A particularly difficult situation is created if genetic problems are combined with external aggressor factors.

Diagnosis of congenital clubfoot

The task of diagnosis is to distinguish true clubfoot from positional clubfoot, when all bones are developed normally, but the joints are in a state of subluxation.
During the examination, the doctor tries to return the feet to the correct position with his hands. This is only possible with the postural (positional) option. In this case, transverse folds are determined on the back of the foot, and the mobility of the ankle is high. Children under 3 months of age undergo an ultrasound of the lower extremities, since the bones are not yet visible on an x-ray. With sonography (ultrasound), you can see only one projection.

From 3 months, x-rays are taken in two projections, in which the foot is placed in the position of maximum extension - plantar and dorsal. Comparison of images gives a complete clinical picture.

Diagnostics includes assessment of four parameters:

• how far the heel is turned inward (varus);
• how much the heel is shifted upward, the arch is increased, how much the foot is curved towards the sole (equinus);
• how the inner edge is turned upward (supination);
• how much the forefoot is brought to the conditional midline of the body (adduction).

Based on the relationship between these components, a diagnosis is made. In particularly difficult cases, an MRI is performed, but the information content of this study is not much higher than routine radiography.

What to do if your child gets very clubbed when walking

After making a diagnosis, orthopedists immediately begin therapeutic actions to correct the pathology. Treatment depends on the age of the baby, the nature of the disease and the severity. The following methods will help bring your legs into the correct condition.

Fixation with soft bandages and elastic orthopedic structures

For newborns, a complex consisting of massage and exercises is first used. Next, bandage bandages are applied. After the procedures, with a mild degree, this technique brings positive results.

If the pathology is detected at a later age, then a special plaster boot is used. It is used as follows: it is worn for two months intermittently. After seven days of wearing, the boot is removed and the doctor prescribes a massage. Then he is dressed for another week.

Treatment according to Ponseti

Parents often ask the orthopedist what to do if the child is clubbing at the age of 1? At this stage, the most productive method is Ponseti therapy:

• First, the little one is given plaster casts for 2 months.
• Next, surgery is performed to truncate the Achilles tendon.
• Then a removable “Brace” device is applied, which reduces the load on the ligamentous joint.

Physiotherapy

It is necessary in conjunction with other methods to correct the ankle. Since during the procedures, blood circulation in the affected areas of the legs is normalized.

The orthopedist necessarily prescribes: electrophoresis, magnetic therapy and paraffin-based applications.

Injection of drugs into the calf muscle

If clubfoot is detected in a child at birth or at 2-3 years of age, then a Botox injection is given once every six months. It helps to relax the muscle, while the foot takes the correct position.

When diagnosing a pathology due to a nervous disease, doctors prescribe medications containing proserine and strychnine, which improve nerve impulse conduction.

Orthopedic shoes

All of the above methods will give a positive effect if you wear special shoes, shoes, boots and sandals. They must be purchased depending on the season and as the legs grow.

You should buy these shoes (for example, anti-virus children's shoes) according to the recommendations of a doctor, since independent selection will not lead to good results.

When choosing, be guided by the following characteristics:

• The heel should be rigid on both sides and reach the middle of the shin.
• The Velcro system must securely fix the leg.
• The arch support supports the inside of the foot and helps it develop properly.
• Pronator insole.

Specialized stores, such as OrtoPanda, provide a wide range of winter and demi-season shoes of all sizes for boys and girls. You can also purchase insoles, exercise mats and braces.

Go to the orthopedic shoes section

If there are no such retail outlets in your locality, then contact the online store. On the website you will find a photo with a description and price. Consultants will help you make the right choice, tell you which model is best to purchase in your case, delivery conditions and payment method.

Surgery

The surgical method is resorted to if all of the above treatment methods have not given a positive result, and a child at 5-6 years old still has a clubbing when walking.

After surgery, during which an incision is made in the Achilles tendon or it is completely replaced, the ankle deformity is partially or completely eliminated.

Treatment of congenital clubfoot

The treatment method is chosen by a pediatric orthopedic traumatologist, focusing on the severity of the disease and the general clinical situation.
In the vast majority of cases, persistent conservative treatment is sufficient to correct the situation. The most active treatment is carried out from the first days of life, while ossification is incomplete and it is possible to bring the foot to the physiologically correct position without much difficulty. A combination consisting of the following methods is prescribed:

• therapeutic exercises to maximize ankle mobility and prevent muscle atrophy;
• foot massage;
• soft fixation in physiological position with flannel bandages;
• after being brought into the correct position - splint, cut or stage-by-stage plaster immobilization;
• after plastering - wearing special anti-varus high orthopedic shoes (braces);
• physiotherapy – pine baths, paraffin.

Correctly selected conservative treatment allows you to cope with the disease in the first year of life.
If conservative methods fail to get rid of clubfoot, surgery is performed, but not earlier than 1 year. The surgical plan is developed individually, the position of the bones and joints is changed, and the ligamentous apparatus is adjusted. The scope of intervention is determined by individual data. After surgery, plaster immobilization is required for up to 6 months.

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Prevention of congenital clubfoot

There is no specific prevention. It is important for a pregnant woman to avoid exposure to adverse factors, lead a healthy lifestyle, and follow the gynecologist’s prescriptions. After the birth of the baby, you must strictly follow the recommendations of the orthopedist. The team of experienced specialists at the SM-Doctor clinic will help your child get rid of clubfoot. Our orthopedic traumatologists will conduct a comprehensive examination and draw up a program for improving the health of the musculoskeletal system. Sign up for a consultation at convenient office hours!