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The clubfoot is a state of which deformation of foot is characteristic. At the same time foot is rejected inside from a longitudinal axis of a shin. It is accepted to distinguish a clubfoot inborn and acquired. This pathology rather widespread: so, from all inborn deformations the clubfoot makes about 12%. At the same time this illness is found in boys twice more often than at girls, and approximately in half of cases the bilateral clubfoot takes place.
On condition of the child's birth with a clubfoot at healthy parents the probability of the birth and the second child with similar defects increases for several percent (2–5%). However in most cases the clubfoot at children has sporadic character that confirms its origin as inborn defect. Specialists claim that at a fruit development of muscles approximately on 8-12 week of pre-natal development is broken. Researchers state also other origins of similar defect. So, teratogenic action of a number of substances – drugs (Ecstasy), chemical elements can become the reason of deformation of extremities. Also there is a probability of an inborn clubfoot if at the pregnant woman too low volume of amniotic waters is observed (that is an oligoamnios). There is also neuromuscular theory of emergence of an inborn clubfoot. This theory is proved by one of explanations of an origin of fibrosis of soft tissues which is shown owing to disturbance of an innervation because of primary deficit of nerve fibrils. Despite existence of several theories described above there is no correct explanation of an origin of this pathology accurate and only today.
Types of a clubfoot
It is accepted to distinguish some types of a clubfoot according to certain signs. So, from the point of view of an etiology of a disease distinguish: idiopathic (primary) clubfoot and secondary clubfoot. In turn, the secondary clubfoot can be divided into a neurogenic clubfoot, an arthrogryposis and a syndrome of amniotic banners.
From the point of view of weight of this illness distinguish an easy clubfoot (it is rather insignificant deformation of foot which is easily giving in to correction); a moderately severe disease and a clubfoot of heavy degree (strongly expressed deformation of foot, at the same time takes place big rigidity)
Diagnosis of a clubfoot
"Clubfoot" the specialist, as a rule, can make the diagnosis in maternity hospital, being guided by survey of the child and the characteristic deformation found in process. In certain cases outside torsion (that is torsion) shin bones, and also an infleksiya (excess) of a sole can be observed in such a way that because of an excess the cross furrow of Adams is formed. Besides rather often the hypoplasia (that is an underdevelopment) feet, and also the reduced volume of tissues of shin, that is its hypotrophy is diagnosed for the child.
Preliminary diagnosis is carried out, being guided by results of ultrasonic research which to be carried out to a fruit prenatalno in the second trimester of pregnancy (after 16 weeks).
At statement of the similar diagnosis the doctor considers that the clubfoot is very often combined with some pathologies. So, very often in parallel with a clubfoot at children the dysplasia of a hip joint, and also spin of a bifid without clinical picture of a myelodisplasia develops.
Treatment of a clubfoot
In the course of treatment of this illness observance of some principles from which directly envy efficiency of the subsequent therapy is very important. So, it is very important to begin to treat a clubfoot as soon as possible, it is desirable in the first days after the child's birth with pathology. Secondly, in the course of treatment the doctor has to choose such technique to provide full correction of one and all components of deformation. Not less important point at treatment of a clubfoot continuous monitoring and correction of deformations of foot is considered. Such measures should be taken regularly until the foot growth period terminates (at the age of 12-14)
The main conservative method of treatment of a clubfoot plastering is considered today. For bigger effect of treatment corrective massage for two weeks is also carried out. To a cut the plastering method which is combined in certain cases with applications by paraffin is applied after that. Plastering is applied to treatment of similar pathology at children of early age. It is possible to impose gypsum on an extremity already from 3-7-day age. At first the greatest possible correction of foot then the plaster bandage is applied it is reached. The child should change such bandage approximately in one week, after it change through two week. Gypsum is not removed until full or greatest possible correction of foot is reached.
Correction of the deformed foot is carried out in a certain order. At first it is adjusted varus and reductions, supination of foot, an ekvinus is carried out then. Imposing of gypsum from three to five months will be the following stage.
However today efficiency of therapy only using traditional plastering makes only 58%.
Except a traditional method of plastering apply also a method of imposing of gypsum today across Pontseti who was called by last name the American orthopedic surgeon. The similar method is considered to be standard in some European countries, and also in the USA. Its efficiency reaches 89%.
At a clubfoot the patient appoints not only plastering, but also carrying splints. These are special orthopedic devices which fix foot in the necessary situation. To manufacture similar adaptation, the plaster cast of legs of the child is used. Adaptation fastens to a leg by means of belts with flypapers. Splints are put on the child's legs generally in the period of a dream. Also according to the recommendation of the doctor carrying tires which fix feet in the necessary situation is applied. The good effect gives also regular carrying special orthopedic footwear.
If massage and plastering yield good result, then the doctor appoints repetition of these procedures. In case of inefficiency of similar methods to the child at the age of 1-2 flyings perform a surgery. An operative measure is necessary approximately in 10-30% of cases of a clubfoot. Such operation assumes tendon grafting of a tibial front muscle on a cubical lateral bone. It helps to prevent further inversion of foot.
Complications of a clubfoot
At the correct approach to treatment of a clubfoot children have very high chances of disposal of this illness. But if the illness does not respond to timely treatment, the risk of an incomplete dislocation of bones of foot appears. At similar pathology skin of feet strongly grows coarse, muscles of a shin do not participate in walking and, respectively, will atrophy. After a while normal functions of knee joints are broken owing to what noticeable disturbances of motive function of legs of the patient are shown.
Section: Orthopedics and traumatology