Is it possible to eliminate congenital clubfoot in children?

The correct position of the foot when walking is very important for the development and normal condition of the spine. In addition to flat feet, children may have congenital clubfoot. Congenital clubfoot is the result of tissue and muscle dysplasia in the foot area.

The reasons for this may be external influences on the fetus during pregnancy, as well as internal reasons - during the laying of organs under the influence of certain factors at 3-4 weeks, the final segment (that is, the foot) does not reach full rotation at the sagittal plane, which leads to muscle dysplasia. This muscle dysplasia causes all the symptoms of congenital clubfoot in a child.

How does congenital clubfoot manifest itself? What is the difference between clubfoot?

Symptoms of congenital clubfoot are the incorrect position of the foot relative to the leg. Consider which muscles and in what position they are, why they make the foot of the foot be in the wrong position. The gastrocnemius muscle is in a state of equinus (plantar flexion), the posterior muscles of the lower leg are in stable supination, and the long flexor of the first finger is constantly in the adduction position, which is due to dysplasia and fibrous process in the ligamentous apparatus of the supracalcaneal-ankle joint.

The development of pathognomonic symptoms has 3 degrees of severity, which differ in the angle of rotation of the foot. In a severe degree, an Adams furrow forms on it. In this case, the foot seems to be shortened, and the heel is raised up. After identifying suspicions of clubfoot in a child, it is necessary to conduct a differential diagnosis between diseases that are similar in clinical manifestations to congenital clubfoot.

Differential diagnosis of congenital clubfoot:

• Arthrogrypposis – congenital disease of the locomotor system, which is manifested by abnormalities in the development of bones, muscles, joints, multiple defects, contractures and stiffness of the joints. With this disease, some muscles are absent or in a state of dysplasia.
• Amniotic bands – with them, there are defects on the lower leg, and a deep circular constriction is visualized.
• Spastic clubfoot – in this condition, the tone of the muscles of the foot is disturbed, the doctor can passively remove the foot from such a position, which is impossible to do with congenital clubfoot.

Specific X-Ray Signs of Congenital Clubfoot

To confirm the diagnosis, an X-ray examination is performed, the result of which is carefully studied. Specific x-ray signs of congenital clubfoot in children on x-ray:

• If you draw a line along the axis of the first and fifth metatarsal bones, then an angle is formed, which should normally be 25-28⁰, and with clubfoot it reaches 45-50⁰.
• Supraheel index angle reduced.
• If you draw the axis along the first metatarsal and calcaneus, then the angle should normally be 145-150⁰, and with congenital clubfoot it is 80-90⁰.

Treatment of congenital clubfoot consists of 3 periods – before the first year of life, after the first year, and anti-relapse.

How is congenital clubfoot treated? When is surgery indicated?

Treatment should begin in the second week of life, after umbilical ring fusion. A positive effect can be achieved by regular massage. Perform the so-called redress – forcible removal of defects and fixation of the foot in the correct position with flannel bandages according to Fink-Eptingen.

This method of applying a bandage is used up to 3-3.5 months, then the deformity in clubfoot is corrected with a plaster bandage like a boot. Massage with muscle stimulation can relieve a child from clubfoot. If these methods did not have a positive effect, and the congenital clubfoot only progresses, surgical intervention according to the Zatsepin method is indicated. The operation is performed only after 7 years, since by this age the arch of the foot is already fully formed.