congenital clubfoot
Introduction
Introduction to congenital clubfoot The talipesequinovarus is one of the most common congenital malformations, accounting for approximately 77% of congenital foot deformities. The deformity of the horseshoe is composed of three factors: the foot is drooping, the inversion is turned, and the inward is received. Patients may be accompanied by other malformations, such as congenital dislocation of the hip, and refers to the muscular torticollis. This disease can be found at birth, most of the treatments are timely and the curative effect is better. basic knowledge The proportion of illness: the incidence rate of infants and young children is about 0.005%-0.006% Susceptible people: young children Mode of infection: non-infectious Complications: ischemic necrosis
Cause
Congenital clubfoot
Genetic factors (15%):
The disease often has a family history and has a certain relationship with heredity. For example, Wynne-Pavis reports that the proportion of patients with family history is 2.9%. In addition, the incidence of single-oval twins is much higher than that of double-oval twins. 33:3, although heredity is an important factor, it is not yet possible to determine the laws of dominant, recessive or associated genetic inheritance.
Embryo factor (20%):
Bohm believes that within three months of the embryo, the three primitive malformations of the horseshoe inversion are sagging, adduction and supination (inversion). Since the fourth month, the foot is in the neutral rotation position, the tibia Mild adduction, the foot also begins to rotate along the long axis, close to the position of the normal human foot, any developmental disorders will keep the foot in the early deformed position of the embryo.
Intrauterine factors (14%):
The fetus is in poor position in the uterus, the foot is under pressure, and it is in the foot for a long time, followed by varus, and the sag of the ankle. Accordingly, the muscles on the posterior and medial side of the calf are shortened, and the medial joint capsule is thickened to further the foot. In a deformed position.
Environmental factors (10%):
Many scholars have found that this disease is related to environmental factors, such as Dulashmami injection of insulin into the developing chicken embryo, causing a deformity of the clubfoot. It has been shown that hypoxia may cause clubfoot in the critical moment of limb development, Stewart It has been found that in many patients from Japan, the incidence is particularly high due to the habit of sitting on the varus.
Prevention
Congenital clubfoot prevention
The disease is a congenital disease, no effective preventive measures, early diagnosis and early treatment is the key to the prevention and treatment of this disease. At the same time, children with this disease should pay attention to functional exercise, functional exercise is a child with congenital clubfoot after discharge. A very important part of the project, reasonable and active functional exercise can quickly restore the affected limbs to normal levels, but early children are unwilling or afraid to move, so it is necessary to explain the importance of functional exercise to the parents of the child. The enthusiasm of mobilizing the parents of the children or accompanying the family, combined with the necessary passive exercises, can effectively reduce postoperative complications, and should adopt a step-by-step approach.
Complication
Congenital clubfoot complications Complications ischemic necrosis
1. Long-term weight bearing, thickening of the sac and sputum on the dorsal side of the foot, a small number of ulcers.
2. The postoperative complications of children mainly have the following performances:
(1) Postoperative pain: For children who are fully awake after surgery, the response of the cerebral cortex to pain is affected by psychological state, so tension, anxiety, and fear all lower the pain threshold.
(2) pressure sores: children with congenital clubfoot due to long-term bed rest lack of exercise, resulting in poor blood circulation in various parts of the limb, the pressure part is easy to cause pressure sores.
(3) Limb ischemic necrosis or muscle contracture: its initial performance is mainly due to the pale color of the affected limb, the temperature is lowered, the skin is dull, and it is unable to move on its own or local persistent pain. At this time, the plaster bandage should be cut open to avoid limb deficiency. Bloody necrosis or muscle contracture occurs.
Symptom
Congenital clubfoot symptoms Common symptoms Horseshoe varus muscle atrophy Spina bifida
Since the foot deformity can be seen after birth, it is usually not difficult to diagnose. The congenital clubfoot can be generally divided into a stiff type (internal type) and a soft type (external type).
Stiff type
The deformity is severe, and the ankle and subtalar joint flexion deformity is obvious. The talus is flexed, and the protruding talus head can be touched from the dorsal side of the foot. The heel seems to become smaller because the posterior side of the lower end of the humerus is turned upside down. It looks like no stick and stick-shaped, so it is also called stick-shaped foot, with severe contracture. From the rear, the calcaneus is inverted, the forefoot also has adduction varus, and the scaphoid is located deep inside the foot, close to the talus. The humerus protrudes to the lateral side of the foot, the medial side of the foot is concave, the medial ridge of the medial aspect of the ankle and the medial aspect of the heel are increased, and the skin of the lateral and dorsal skin is tightened and thinned. When the passive dorsal extension is everted, it is stiff and fixed. Correction, children with difficulty standing, walking delay, limp, support standing can be seen on the lateral side of the foot or the back of the ground bearing weight, slightly longer, obvious claudication, soft tissue and joint stiffness, small feet, small legs, muscle atrophy, but feel normal, After long-term weight bearing, there may be thickened bursae and sputum on the lateral side of the foot, and a few ulcers occur.
The patient often had other malformations at the same time. Of the 351 patients who were followed up for more than 2 years, 45 (12.8%) were associated with other malformations, including 17 cases of recessive spina bifida, 7 cases of congenital dislocation of the hip, 4 cases of multiple finger deformity, and the spine. There are 3 cases of scoliosis, in addition to the calf ring band, etc. This type of treatment is difficult and easy to relapse. Most people think that this type is caused by defects in embryos or genetic factors.
2. Soft type
The deformity is lighter, the size of the heel is close to normal, and there are mild skin folds on the outside of the ankle and the back of the foot. The calf muscles are atrophied and not obvious. The biggest feature is that the horseshoe varus deformity can be corrected when the passive back extension is everted. To make the foot reach or close to the neutral position, this type of deformity is soft and easy to correct, the effect is easy to consolidate, it is not easy to relapse, and the prognosis is good. This type is caused by abnormal intrauterine position.
Examine
Congenital clubfoot examination
The disease can be diagnosed according to the clinical manifestations, generally do not need to be diagnosed according to X-ray examination, but for the objective evaluation of the degree of deformity of the horseshoe and the therapeutic effect, X-ray film is indispensable, normal newborn foot X-ray film can be seen, the distance from the center of the humerus, the ossification center of the foot of the foot of the horseshoe is late, the scaphoid appears only after the age of 3, and the humerus is well ossified after dryness. .
1. Normal position of the normal talus longitudinal axis and the longitudinal axis of the calcaneus have an angle of about 30 °, if less than 20 °, showing the posterior varus, the normal foot 1 tibia and talus vertical axis, the 5th tibia Parallel or perpendicular to the longitudinal axis of the calcaneus is less than 20°, greater than 20°, indicating the front adduction.
2. Lateral radiograph The normal longitudinal talus longitudinal axis is parallel to the first metatarsal, and the patients in the clubfoot are intersected at an angle.
Diagnosis
Diagnosis and diagnosis of congenital clubfoot
diagnosis
1. After the baby is born, there is a deformity of one or both feet of the plantar flexion.
2. The anterior part of the foot is varus, the talus is flexed, the calcaneus is inversion, the Achilles tendon, the fascia is contracted, the forefoot is widened, the heel is narrowed, the arch is high, the lateral malleolus is prominent, and the medial malleolus is posterior. Not obvious.
3. When standing and walking, the outer edge of the ankle is loaded with weight. In severe cases, the outer edge of the foot is loaded with weight, and the weight-bearing area produces bursitis and sputum.
4. Unilateral malformation, walking limp, bilateral deformity, walking swing,
5. X-ray film: the talus intersects the longitudinal axis of the first metatarsal bone at an angle greater than 15°, and the angle between the humeral surface and the longitudinal axis of the talus is less than 30°.
Differential diagnosis
1, neonatal foot varus:
Neonatal foot varus and congenital clubfoot look similar, mostly on one side, the foot is horseshoe varus but the inside of the foot is not tight, the foot can reach the front of the humerus and can be completely normal after 1 to 2 months of treatment.
2. Neurogenic horseshoe foot:
The horseshoe foot caused by nerve changes gradually changes with the child developmental malformation. It should pay attention to whether the function of the intestine and bladder changes, and whether there is numbness on the lateral side of the foot, paying special attention to the pigmentation of the lumbosacral sinus or sinus and skin. If necessary, MR I should be performed to determine the presence of tethered cord system. Electromyography and nerve conduction function tests are helpful for understanding nerve damage.
3. Horseshoe foot after polio:
At the time of birth, the appearance of the foot is not deformed. The age of onset is more than 6 months. There is a history of fever. It is more common on one side, accompanied by long and short tendon of the humerus. There is no fixed deformity in the early stage, normal bowel movements, and other muscle spasms.
4, the cerebral palsy after the horseshoe foot:
Perinatal or postnatal hypoxia history, most of them found abnormal after birth, the clubfoot deformity gradually grows with the growth, but can disappear or reduce during sleep, once the stimulation deformity is more obvious, the horseshoe is dominant, the varus is less, No adduction, deformity mostly bilateral or ipsilateral upper and lower limbs, double lower limbs cross gait, lower extremity tendon, often accompanied by mental decline.
5, multiple joint contractures:
The clubfoot is bilateral, and the foot deformity is part of multiple joint deformities throughout the body. Most of the muscles in the body are atrophied, hardened, and the fat is relatively increased. The horseshoe foot stiffness is not easy to correct, and the hip and knee joints are often affected.
