Clubfoot (ekvinovarusny deformation of foot) – one of the most widespread anomalies of development of bone and muscular system (33-38%). As a rule, arises from two parties. At boys the clubfoot comes to light twice more often than at girls. The clubfoot is characterized by a deviation of fingers of a knutra, a podgibaniye of an inner edge of a sole up and knutr. The clubfoot happens idiopathic, position, congenital and sindromologichesky. Diagnostics of a clubfoot at children up to 3 months is carried out by means of ultrasonography, at children of more advanced age - by means of a radiological research. Treatment is performed by the orthopedist and includes wearing orthopedic footwear, massage, gymnastics, physical therapy, use of plaster bandages and special tires is possible.
Clubfoot (ekvinovarusny deformation of foot) – one of the most widespread anomalies of development of bone and muscular system (33-38%). As a rule, arises from two parties. At boys the clubfoot comes to light twice more often than at girls.
The reasons of development of a clubfoot are up to the end not clear. The modern traumatology and orthopedics assumes that anomalies of provision of a fruit, a lack of amniotic waters, smoking, alcohol intake and narcotic medicines can be risk factors of emergence of a clubfoot. Owing to an adverse effect on a fruit development of bones of foot, muscles and nerves of a shin is broken. The secondary clubfoot arising owing to pathology of other departments of bone and muscular system is possible.
Allocate the following types of a clubfoot:
- Idiopathic clubfoot. It is characterized by the reduction of a collision bone which is combined with a pathological arrangement of her neck, ekvinusy (horse foot) at which the heel is tightened up, and foot is bent towards a sole, violation of an arrangement of a forward part of foot in relation to back, by violation of development of articulate surfaces of joints of foot, shortening of a gastrocnemius muscle, violation of development of tibial vessels in forward departments of a shin.
- Posturalny (position) clubfoot. Calcaneal and collision bones are not changed. Articulate surfaces are normally developed and are in a condition of an incomplete dislocation.
- The congenital clubfoot which is combined with congenital neuropathy and a myopathy. Deformation of foot has secondary character, is caused by pathology of development of other departments of bone and muscular system (multiple curvatures of bones of extremities, bilateral congenital dislocation of a hip, etc.).
- Sindromologichesky clubfoot. Combination of the previous form of a clubfoot to extra skeletal pathology (amniotic banners, anomalies of development of kidneys, etc.).
At a congenital clubfoot varusny deformation (foot is turned in, fingers are rejected knutr) and a supination is observed (foot is developed by a sole up and knutr). The movements in an ankle joint are limited. Because of change of provision of foot the child with a clubfoot when walking leans not on all sole, and on the outer edge of foot. A peculiar gait at which the patient during each step steps through a supporting leg develops.
Over time violations are aggravated. Bones of foot are even more deformed, there are incomplete dislocations in foot joints. Skin of an external surface of feet becomes rough. The muscles of shins which are not participating in walking atrophy, work of knee joints is broken. The later treatment of a congenital clubfoot is begun, the it is more difficult to compensate the arisen violations and to get into condition foot.
It is important to define whether the clubfoot is true (the foot caused by violation of development of bones) or position. At a position clubfoot of stop of the patient is more mobile, it is actively or passively removed in normal situation. Ekvinus is poorly expressed. On the back of foot there are cross folds testifying to sufficient mobility. As a rule, the position clubfoot independently disappears within the first weeks of life of the child, however, at identification of this form of a clubfoot conservative therapy is anyway shown.
Radiographic methods of a research are not informative at inspection of children up to 3 months as they at this age of a bone consist mainly of cartilaginous tissue and are not displayed on roentgenograms. To children is more senior than three months conduct a radiographic research in two projections: forward-back and side. Roentgenograms become at the greatest possible plantar and back bending of foot. For inspection of children up to 3 months ultrasonography is used. This method is absolutely harmless, but is less informative as it allows to see only one of two levels (a side view or from above).
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Tactics of treatment of a clubfoot is chosen the orthopedist depending on expressiveness of pathology. Treatment has to be earlier, consecutive and constant. The result of treatment depends on clubfoot degree. At easy degree of a clubfoot in 90% of cases it is possible to achieve correction of provision of foot without operation. Heavy degree of a clubfoot improves conservatively in only 10% of cases.
Conservative therapy of a clubfoot begins with the first weeks of life of the patient as during this period bone structures of foot of the child very soft and to stop can be transferred without operation to the correct situation. The remedial gymnastics and massage of feet is appointed. Soft fixing of feet by means of flannel bandage is applied. After correction of a form of foot on a leg of the child impose the special tire. At more expressed clubfoot stage-by-stage removal of foot is carried out to the correct situation with use of plaster bandages.
In the subsequent physiotreatment, massage, remedial gymnastics, wearing orthopedic footwear is shown to children with a clubfoot. For the night on legs impose special polyethylene tires. At inefficiency of conservative correction of a clubfoot operation is carried out. Surgical treatment is carried out on reaching the child of age of 1-2 years, includes plasticity of sinews, the copular device and aponeuroses of foot. In the postoperative period carrying plaster bandages for up to half a year is appointed.