Clubfoot

Q: My wife is in her 9th month of pregnancy. The doctor asked for a scan. The scan revealed that the baby has left foot talipes. What is talipes, its cause, how to cure it and any long term / lifetime side effects on the babys life? Please help us, we are very much worried. Thank You.

A:Talipes means any deformity of the foot involving the ankle. Also known as clubfoot, it is a congenital deformity, which means it is present at birth. In patients with clubfoot, the bones, joints, blood vessels, and muscles in the foot are formed incorrectly resulting in varying degrees of deformities. It can affect one or both feet, more frequently the left. In about half of the cases, both feet are affected. Clubfoot can occur by itself or it can be accompanied by other birth defects such as malformation syndromes or chromosomal syndromes. There are three types of clubfoot: 1. Talipes Equinovarus: Foot is turned inward and down and is quite commonly seen. 2. Calcaneal Valgus: This is an angling of the foot at the heel. When this occurs, the top of the foot looks as if it is bent to the side and the toes point up and out. 3. Matatarusus Varus: Front of the foot is turned inward. But whatever the type of deformity, each child is likely to have some of each of the following: - Plantar flexion - refers to the twisting of the ankle causing the heel to be drawn up. - Cavus foot deformity - refers to the high arch of the foot, noticeable in some cases. In other cases, because of the angling of the foot, the height may be difficult to determine. In these cases, a crosswise crease on the sole of the foot may be a good indication. - Varus - refers to the inversion of the heel which causes the front of the foot to turn inward. - Adduction of the forefoot - this refers to amount the forefoot is pulled downward There is no one known cause for clubfoot. Some doctors think it may happen in the womb due to cramping or twisting, somewhere around the 10th - 12th weeks of pregnancy. Others believe that heredity or other factors known to cause birth defects may be to blame. These include use of drugs or alcohol, or experiencing certain diseases. However, there is no proven cause for the condition. And, in most cases, no cause can be found. There are some diseases such as myelomeningocele and constriction band syndrome that may lead to clubfoot. Twice as many boys as girls have clubfoot and heredity may be a factor. The symptoms of clubfoot are noticed at birth and include: - Noticeable deformity in foot - Stiffness in ankle or in foot tendons - Calf appears shorter than the other leg (in cases where only one foot is affected) - Foot or feet turned or twisted awkwardly - Affected foot lacks the normal range of motion It is important to treat clubfoot as soon as it is diagnosed to avoid later problems. With proper and professional treatment, clubfoot does not represent a long-term disability or handicap. In many cases, it can be corrected within about six to eight weeks by exercise, manipulation and stretching of the heel cord, and casting. Chances of correction are optimal during the first two weeks of life, when the tissues and ligaments are very elastic-like and pliable. Only experienced orthopedic surgeons should attempt to correct the condition since cases that are treated poorly treated can further complicate the condition. In more severe cases of clubfoot, surgery may be required to lengthen the heel cord. The forefoot correction and hindfoot correction take more time and the heel cord lengthening can be left until the child is older. The less invasive treatments may be thought of as failing if there are no results after three or four months. The surgery can be accompanied by scarring, stiffness and muscle weakness that can become disabling in later years. If passive treatment of the condition, such as using stretching or casting or both, is used, it is important to have the foot evaluated periodically.

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