What to do if your child has clubfoot?

Clubfoot is a congenital anomaly called equinovarus foot deformity. Visually, it looks like a foot turning inward. It is corrected by orthopedic surgeons. Squinting occurs in three out of every thousand children, with boys being twice as likely to be affected as girls.

Baby tiptoes

Our child is tiptoeing – what should we do? Parents often ask me this question during office hours. It is very important that the child immobilizes the entire foot when standing and walking. Not only the toes, but also the heel must be in contact with the surface. It is acceptable to stand on only one toe and lift the heel if, for example, the child is walking. B. wants to grab or see an object. As soon as the child has seen or grasped the object in which he is interested, he should stand with his whole foot again. Incomplete support with movement occurs when the child runs or walks quickly during an emotional outburst. In contrast, the child should walk in a calm state with his feet on full support.

If the child walks on tiptoes, it is first necessary to determine whether walking on tiptoes is the result of emotional expression or whether it is a pathologically increased muscle tension. To do this, carry out the following test: place the child on his back on a table or sofa, stretch his legs out and hold them with your hand at the knee joints, pressing them against the surface of the table or sofa. With your other hand, bend your feet so that they form a right angle.

Feel the tension in your calf muscles. Concentrate on the movements you are making in the child's joints. If you feel any muscular resistance that hinders or restricts movement at the ankle during the test, you are dealing with increased tone or contraction of the calf muscle. This muscle prevents the heel from sinking to the ground when the child is walking or standing. During the examination, the child's toes may tense, the muscles of the hamstrings and trunk may tense, and discomfort may be felt. If the child's increased emotionality is responsible for toe walking and the muscle tone is not changed, no obvious muscular resistance to the movement will be felt on examination. The cause that caused the child to tiptoe determines the recommendations for correcting the foot position. There are situations where toe walking is related to birth trauma and neurological symptoms. In this case, a consultation with an osteopath or pediatric neurologist is required.

This is important!

It is a mistake to think that children who walk on tiptoe will learn to walk properly as they get older. Tiptoe walking can continue until school age. This means that the time during which a child can develop the arches of the feet and have a correct gait, good posture and straight legs is on their toes. It is therefore unlikely that all of these elements will form properly. As soon as you notice that your child is walking on tiptoes, you should try to correct the situation without waiting until he is older. The sooner you start doing this, the easier it will be to correct the anomaly. As mentioned earlier, you need to determine the cause of the change in gait. Let's look at what you can do at home if tiptoe walking is associated with increased calf muscle tension. These suggestions can also be used as an adjunct to neurological treatment.

1. Foot and buttock massage as 10 sessions. A description of the massage technique can be found at this link: Foot massage
2. special exercise program
3. corrective footwear.

It may be necessary to repeat another course after 1.5-2 months, and then after another 3-4 months. The more serious the problem, the more courses are required.

When performing massage and exercise, it is important to remember that the emphasis should be on stretching the calf muscles to reduce contraction of these muscles and restore their elasticity. In this way, the child will better get used to walking on the full foot all day, ie putting the heel on while walking.

You can now begin teaching and performing the exercises. If the child walks on toes, the exercises will help maintain the correct range of motion in the ankles and change the abnormal walking stereotype.

Causes of Clubfoot

Congenital clubfoot can be genetic, but is more often caused by an external factor. According to research, the most common cause of congenital clubfoot in a child is:

• Fusion of the amniotic membrane (the watery membrane that surrounds the fetus in the womb) with the lower extremity;
• Mechanical compression of the amniotic membrane on the fetal foot or traction on the foot by the umbilical cord;
• Abnormal formation and development of the lower limbs in the first trimester of pregnancy. This can occur as a result of infectious viral diseases and severe stresses on the mother during this period (long-term observations show that the number of newborns with this pathology increases sharply in the war and post-war years);
• pressure of the wall of the uterus on the foot due to insufficient amniotic fluid (dehydration);
• Mechanical impact of a uterine tumor on the baby's foot;
• toxoplasmosis acquired during pregnancy;
• Abnormalities of the baby's spinal nerves.

Important!

Thanks to modern diagnostic equipment for examining pregnant women (ultrasound), doctors can diagnose clubfoot before the child is born. In this case, the adults are prepared to take urgent measures to fix the problem. The success of the treatment depends on the timeliness of these measures.

Clubfoot in a child can be caused by various traumas: severe burns, mechanical damage to the bones and musculoskeletal system of the foot. Fractures of the foot and lower leg that have not healed properly, frequent ankle sprains, sprains and torn ligaments lead to clubfoot when the child walks. Rickets and poliomyelitis can also cause acquired clubfoot.

Clubfoot classification and clinical picture

Why does a child have a clubfoot? Doctors distinguish between four main forms of equinovarus foot deformity in children (the so-called club foot). This classification focuses on etiopathogenesis - the causes and mechanisms of the malformation. Clubfoot can be:

• Typical. The exact cause of this type of pathology has not yet been established. It is characterized by dysplasia (underdevelopment, underdevelopment) of the ankle joint and a violation of the anatomical structure and location of the muscles and ligaments. With this form, one-stage correction is not possible even in the first days after birth - long, gradual treatment is required;
• Postural defects – caused by shortening of muscles and ligaments without damage to bones and joints. It is caused by abnormalities during fetal development;
• Secondary - caused by various congenital anomalies of the neuromuscular system. The clinical picture is directly related to the underlying disease;
• Arthrogryposis caused by a severe joint pathology.

In the typical and positional form, both limbs are often affected, while in the secondary and arthrogryposis only one limb may be affected - the child then stands on one leg. Depending on the extent of the affected limb, the degree of abnormality varies:

• Mild – there is no restriction of movement in the ankle, foot alignment is corrected with light hand pressure. Sometimes the child walks normally in summer sandals, but with clubfoot in winter shoes - voluminous and soft;
• Moderate – ankle movement is significantly limited and there is a springy stiffness combined with some resistance when attempting to correct foot alignment;
• Severe – there is a severe deformity of the foot and ankle that cannot be corrected with manual treatment.

internal rotation of the tibia

In internal rotation of the tibia, the tibia (which has a supporting function) is rotated slightly inward about its axis. If you place a child on the edge of a chair and let them hang down, their ankles will be turned inwards and their feet and knees will be in a 'straight' position.

In the history of orthopedics, a variety of treatment methods have been used, ranging from systematic changes in foot position during sleep to orthopedic shoes and surgical interventions (derotational osteotomies). However, it has been shown that internal rotation occurs in most healthy children in the first year of life and spontaneously recovers as the child grows.

Anteversion of the femoral neck

In femoral neck anteversion, the femoral neck is directed forward in relation to the body, resulting in a slight inward rotation of the entire lower extremity (and therefore the foot). This condition has also been treated using various techniques, but it has been shown that in most children it is an age-related phenomenon that is spontaneously 'corrected' as they grow. At birth, the angle between the femoral neck and the femoral shaft in the horizontal plane can be up to 45 degrees and gradually decreases through adolescence. However, the most common hip problems occur between the ages of 2 and 8 years. This is because from birth until the beginning of safe walking, the hips are rotated outward to ensure stability in an upright position.

None of the previous treatments have been shown to be useful or effective.

Clubfoot in children: treatment with exercises

These are passive and active exercises that must be selected by the doctor for the child concerned. Again, the most commonly used exercises in the treatment of clubfoot in children should not be blindly copied. The complex is calculated based on the severity of the disease, the chosen therapeutic correction methods, the stage of the therapeutic process and the age of the child. Physical activities suitable for children's elastic bones are prohibited for older children. The parents of our patients receive a comprehensive range of physical activities. A visit to the gymnastics room for movement training is possible.

Special orthoses are recommended for permanent wear. These are distinct from those sold under that name in mass stores. These are prophylactic shoes that have no therapeutic effect and are so called for marketing reasons.

Real orthoses, shoes and insoles are made to order only. They should not be passed on to other children, even members of the same family, and it is advisable to change them when the alignment of the foot changes.

In our center you can order individual orthoses using Surcil-Ortho technology, get a prescription for orthopedic braces (shoes with a metal splint inside) and orthopedic insoles.

TREATMENT OF VARUS DEFORMITIES

There are several methods available for treating varus feet:

gymnastics
The gymnastics serve to strengthen the foot and ankle muscles. The exercises can also be done at home, but it's important to pay attention to your technique. Remember that gymnastics performed incorrectly will not bring positive results.

Clubfoot in children
massage
– is one of the most popular methods. It restores tone in the outer leg muscles and relaxes the inner leg muscles. The results are usually visible after the first treatment. Another indication for therapeutic massage is valgus foot deformity in children.

In severe cases of clubfoot, doctors prescribe
orthoses.
Such aids help to keep the foot in the correct position. However, there are also joint orthoses that limit the movement of the joints but do not impede them.

surgical treatment
is only indicated if other conservative measures have failed.

ORTHOPEDIC SHOES

Orthopedic shoes for children with clubfoot have their own characteristics. They are usually made individually for the respective foot deformity. If a child has more clubfoot on one foot than the other, this will also be taken into account when choosing shoes.

The following orthopedic shoes are suitable for the varus foot deformity:

• high or medium heel, which must be higher than the ankle;
• at least 2-3 Velcro straps or buckles to secure the foot;
• rigid buttocks – these should hold the foot in the correct position and not deform when walking;
• rigid side plates – these keep the foot in the correct position and prevent it from tipping over when the child walks with the club foot;
• curved toe area;
• pronator insert; the supinator is contraindicated in these shoes.

Prevention of clubfoot

There is no preventative treatment for congenital clubfoot that is guaranteed to work. This is especially true for children whose families have a genetic predisposition to this disease. However, to reduce the risk of developing a deformity, the expectant mother should follow a few simple rules:

• Pay attention to your health and see your doctor at the slightest sign of infection;
• Eat a healthy diet to provide yourself with all the necessary vitamins and minerals;
• Avoid stress.

After the birth of the child, the position of the legs should be observed. The changes are particularly noticeable during sleep, when the baby is maximally relaxed. To prevent orthopedic foot diseases in children, orthopedic mats and high-quality shoes with firm heels are often used. A very important factor is a healthy lifestyle and good nutrition. Vitamin D can be included in the diet after consulting the pediatrician.

Clubfoot is a deformity that is reversible in almost 100 % cases. The most important thing is to diagnose the deformity early and seek professional help. An experienced Daily Medical orthopedic surgeon can help quickly diagnose and treat the problem.

diagnosis and treatment

A qualified doctor can immediately identify clubfoot based on external signs, but X-rays, ultrasound and CT scans are also prescribed to confirm the diagnosis.

Clubfoot treatment is comprehensive - this is the only way to achieve complete healing. The following recommendations are applied:

• physiotherapy exercises;
• Bandaging, plaster or splinting of the foot;
• massage in case of clubfoot;
• Wearing special orthopedic shoes.

If the course is severe, surgical intervention to stabilize the foot and ankle is indicated.

Clubfoot: Physiotherapy, conservative or surgical treatment?

Mild clubfoot: Physiotherapy, massage, orthopedic aids are effective as the deviation is minimal.

Anastasia

Congenital bilateral atypical clubfoot

Miroslav

Congenital bilateral severe clubfoot

Alexander

Congenital severe clubfoot on the right

Maria

Conservative treatment of clubfoot.

In the vast majority of cases, the treatment of clubfoot is conservative.

The classic method for treating club feet is the Ponseti method. It was proposed by Ignacio Ponseti in 1950 while working at the University of Iowa in the USA and is now the standard of clubfoot treatment worldwide.

It consists of a gradual cast with gradual correction of all four components of the foot deformity, a tenotomy of the Achilles tendon, and subsequent orthopedic splinting until the age of 2-3 years.

The first step is to eliminate the cavus deformity by slightly elevating the 1st metatarsal while keeping the foot in supination.

The second step is to eliminate internal rotation of the heel bone and supination of the foot. To do this, pressure must be applied at certain points: fixation of the ankle joint by applying pressure to the medial malleolus, fixation of the talus by applying pressure to the outside of its head, correction of supination by applying pressure to the first metatarsal bone to a neutral position and rotation of the heel bone outwards through Pressure on the inside of the heel bone.

Excessive pronation of the forefoot should be avoided as it can lead to the opposite form of foot deformity.

The third stage is further retraction of the forefoot into an overcorrection position. This usually requires at least 2 more plaster casts.

The fourth stage is the elimination of the equinus position. Not all cases can be corrected with a cast alone. By shortening the Achilles tendon and contracting the calf muscle, the elimination of equinus can cause overloading of the metatarsals, resulting in valgus or valgus foot deformity.

What is clubfoot and what types are there?

True clubfoot is a congenital or acquired deformity of any part of the foot. The congenital form of the disease is the most common. The child's feet are turned in', the arch is high and often stiff. It is difficult to miss and treatment begins as early as 7-14 days after birth. This form of the problem is a structural problem, that is, it is caused by actual changes in the anatomy and definitely requires the intervention of a doctor.

A completely different situation is the frequent running of the child with the socks inside. In this case, the cause is usually not a peculiarity of the foot, but rather the structure and tension of the hip joint area. The rotation (rotation) of the leg takes place in the pelvis, which is disturbed by muscular imbalance or abnormalities of the femoral neck. Excessive rotation of the leg is usually functional and reversible if no other signs of nervous system or musculoskeletal disease are noted.

Basic exercises

A floor mat, an exercise stick and an exercise ball should be available for the exercises and the room must be well ventilated. It is important that clothing and shoes are comfortable and breathable, do not hinder movements and do not put pressure on the body. Do not start training on a full stomach: eat at least an hour and a half beforehand.

All exercises begin with a warm-up phase. Children should walk on tiptoes, move their arms in different directions, stretch and bend, and warm up their muscles. To relieve the strain on the spine, it is advisable to move on all fours: you can ask children to imitate animals, e.g. B. a cat or a dog. After warming up, you can proceed to the main complex.

prevention of scoliosis

To prevent the disease, you should introduce children to physical activities as early as possible: regular exercise, active games instead of computer games, spending more time outdoors. It is important to control how much time your child spends in front of the television, on the computer or with gadgets, as these are the most likely to trigger scoliosis.

The child's bed should be adapted to their height and as comfortable as possible. It is advisable to choose an orthopedic mattress and a moderately firm mattress so that the spine does not bend during sleep.

The table at which the child studies and the chair should also be selected according to the child's height and should be stable and comfortable. Pay attention to your child's posture when sitting at the table.

Video – exercises for scoliosis in children

• Causes of tiptoe walking in babies.
• Why does a child develop clubfoot?.
• The child walks on its toes.
• Toe movement in children.
• A child begins to have clubfoot between the ages of 1 and 5.
• How to correct a clubfoot in a child.
• 1 year old child with clubfoot.
• Tiptoe walking.