Clubfoot and Talipes Equiovarus

Subject: Child Health Nursing

Overview

Congenital clubfoot, also known as talipes, is a nontraumatic foot deformity. The foot is twisted or out of alignment. The four lines of movement for these combinations—talipes equinovarus, talipes calcaneovarus, talipes equinovalgus, and talipes calcaneovalgus—can all exhibit deviations in one direction or another. Clubfoot's precise etiology is unknown. Intrauterine malposition of a fetal foot as a result of inadequate fetal neuromuscular development and amniotic fluid loss Starting management with stander footwear as soon as possible—possibly in the infant's first week—is advised. Serial manipulation is used as the first nonoperative management technique, which is followed by immobilization in a plaster cast, adhesive tape, strapping, or splinting. Before a child starts to walk, surgical management is typically carried out at 4 to 9 months of age with postoperative immobilization. During the surgical procedure, bone deformities are corrected and the muscle and tendons are balanced using a combination of fusion, release, lengthening, and transfer.

Club Foot/ Talipes Equinovarus

Congenital clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus and ankle equinus. It is also known as talipes equinovarus

Congenital clubfoot involves bone deformity and mal- position with soft tissue contracture. Common types of foot deformities are:-

Talips equinovarus (most common)
Talipes varus: - an inversion or a bending inward
Talipes valgus: - an eversion or a bending outward
Talipes equinus: - Plantar flexion in which the toes are lower than the heel
Talipes calcaneus: - Dorsiflexion in which the toes are higher than the heel

Causes

Idiopathic
In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital) such as spinal bifida
Cigarette smoking during pregnancy
a family history of clubfoot

Risk Factors

Sex: clubfoot is most common in males
Family history
Smoking during pregnancy
Not enough amniotic fluid during pregnancy
Getting an infection or using illicit drugs during pregnancy

Symptoms

The arch is often raised, and the top of the foot is turned lower and inward, turning the heel inward.
The foot may be so excessively rotated that it seems to be upside down.
Typically, the affected leg's calf muscles are underdeveloped.
The affected foot could be up to one centimeter (or half an inch) shorter than the other foot.

Diagnosis

Presentation of child and comprehensive physical examination including hip examination.
History.
X- ray examination of limb: Antero- posterior view and lateral view.
Ultrasound in pregnancy.

Management

Immediately following birth, a casting of a limb is taken. On the medical side of the foot, successive casts enable progressive expansion of the skin and constrictive tissues. Every few days for the first two weeks, manipulation and casting are repeated. Then, at two-week intervals, manipulation and casting are repeated until the affected limb is cast, which typically takes eight to twelve weeks to achieve maximum correction. An X-ray of a limb will be taken during this time to periodically assess the correction.
Surgery will be performed if casting fails to repair the damaged limb. In surgery, stiff joints and tendons are released as well as pins are fixed. Many kids who had their clubfoot surgically fixed were able to run and play. Surgery should be performed between the ages of 6 and 12 months, although if possible, it can be done as early as 2 to 3 months.

Nursing Care of Child with Clubfoot

Nurses should be aware of when the cast sets after being applied.
Should be aware that drying takes 24 hours. To prevent cracking, the plaster should be shielded from unusual pressure or movement, exposed to the air, and covered with blankets.
To prevent pressure being placed on the limb, it should be supported on a pillow.
The color, temperature, pressure, and swelling of the exposed areas of the limb should be closely monitored at all times.
Examine the area beneath the plaster cast for pressure, plaster sores, soreness, itching, or burning.
To avoid the bony prominences when removing a plaster cast, cut the plaster over soft tissue.
Frequent temperature checks and recording,
Cast extremity that is elevated,
Tell the youngster to report any tingling or numbness they experience.
Never use your fingers to handle a damp cast.
Review your respiratory health.
The skin has to be cleaned and dried once the cast has been removed. The best way to treat desquamation is to apply petroleum jelly or skin cream.
Frequent positional changes,
Encourage early and frequent ambulation.
Introduce the use of mobility aids like crutches for a cast leg.
Offer divertional treatment while also promoting the utilization of muscles during play.
Exercise your range of motion.
Convey comfort,
Help parents plan appropriate activities, ensure that parents are aware of the signs of circulatory impairment and infection, and educate them on how to care for and support cast parts.

Nursing Care of Child with Traction

To the kid and family, describe various traction devices.
Decide how the kid may engage in this care together.
Make sure the youngster knows how to seek assistance.
Assure the youngster that he or she won't be left completely defenseless.
Recognize the goal of traction application.
Examine the intended line of pull and the connection between the distal and proximal pieces.
Check the operation of each component portion, including the placement of bandages, the frame, the splints, the ropes, the weight, and the location of the bed.
Keep skin traction adhesive straps and skeletal traction in place.
Verify the pin screws in the metal clamp that holds the traction equipment to the pin to make sure they are tight.
Inspect the body for proper alignment, paying special attention to the shoulders, hips, and legs. Check after the kid has moved, use restraint where necessary, and maintain proper angles at joints, for starters.
Bryant's hip traction is at a 90-degree angle.
Examine the child's behavior to determine whether the traction is painful or uncomfortable.
Circulation is changed while pressure points are gently massaged.
provide a pressure mattress for the back and hips.
Check total body skin for pressure sores,
Assess restraining devices,
Deep breathing exercises frequently with inspiratory chest expansion,
Encourage fluid intake, provide nourishing, non- constipating diet with preferred foods and make certain that child taking sufficient amount of calcium,
Administer pain medication as needed during first 2-3 days of fractures.

Complication

Arthritis,
Poor self-image,
Inability to walk normally,
Muscle development problems.

Things to remember

Congenital clubfoot, often known as talipes, is a nontraumatic foot abnormality. The foot is twisted or out of alignment.
The four lines of movement for these combinations—talipes equinovarus, talipes calcaneovarus, talipes equinovalgus, and talipes calcaneovalgus—can all exhibit deviations in one direction or another.
Clubfoot's precise cause is uncertain.
Intrauterine malposition of a fetal foot as a result of inadequate fetal neuromuscular development and amniotic fluid loss.
Starting management with stander footwear as soon as possible—possibly in the infant's first week—is advised.
Serial manipulation is used as the first nonoperative treatment technique, which is followed by immobilization in a plaster cast, adhesive tape, strapping, or splinting.
Before a kid starts to walk, surgical intervention is often carried out between 4 to 9 months of age with postoperative immobilization.
During the surgical procedure, bone deformities are corrected and the muscle and tendons are balanced using a combination of fusion, release, lengthening, and transfer.

Videos for Clubfoot and Talipes Equiovarus

clubfoot / talipes equinovarus / TEV

CLUBFOOT DEFORMITY, CAUSES AND MODERN TREATMENT

Questions and Answers

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Club Foot/ Talipes Equinovarus