Clubfoot

Introduction Congenital talipes equino varus is one of the most common congenital malformations and is deformed after birth. It is characterized by the adduction of the first half of the foot, inversion, varus varus, plantar flexion, and contracture with horseshoe malformation. According to foreign reports, it accounts for 13 of the entire population. Although it is very common in our country, it lacks statistics. The disease has genetic factors, the formation of the horseshoe varus is mainly due to the imbalance of the muscle strength of the foot, that is, the varus muscle (the tibialis anterior and posterior tibial muscles) is strong and short, and the valgus muscle (the tibialis muscle) is weak. Elongation, the flexor digitorum (thigh triceps) is stronger than the dorsiflexors (temporomandibular muscle). The imbalance of the muscles forms a deformity of the bones and joints for a long time, and the deformity is more serious due to the weight on the basis of the deformity.

Cause

Genetic factor

There is a certain relationship between family history and heredity in this disease. For example, Wynne-Pavis reported that the proportion of patients with family history was 2.9%. In addition, the incidence of single-oval twins was much higher than that of twins, with a ratio of 33: 3. Although heredity is an important factor, it is not yet possible to determine the laws of dominant recessive or associated genetic inheritance.

2. Embryonic factors

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 4th month, the foot is in the neutral rotation position, the humerus is slightly adducted, and the foot begins to rotate along the long axis, close to the position of the normal human foot. Any developmental disorder will keep the foot in the deformed position of the early embryo.

3. Intrauterine factors

The fetus is in poor position in the uterus, and the foot is under pressure. It is in the foot for adduction, heel varus, and sagging position for a long time. Correspondingly, the muscles on the posterior and medial side of the calf are shortened, and the medial joint capsule is thickened, so that the foot is further in a deformed position.

4. Environmental factors

Many scholars have found that this disease is related to environmental factors, such as Duvaswami injection of insulin into the developing chicken embryo causing clubfoot deformity. It has been shown that at critical moments in limb development, hypoxia may lead to clubfoot. Stewart found that in many patients from Japan, the incidence was particularly high due to the habit of sitting on the varus.

an examination

Related inspection

CT examination of bone and joint MRI

The disease can be diagnosed according to clinical manifestations, and generally does not need to be diagnosed according to X-ray examination. However, X-ray film is indispensable for judging the degree of deformity of the clubfoot and the objective evaluation of the therapeutic effect. Normal neonatal foot X-ray films can be seen in the center of the fossa of the heel, distance and humerus. The ossification center of the foot bones of the sick children with clubfoot appears later. The scaphoid appeared only after the age of 3, and the humerus was well ossified after dryness.

The disease can be diagnosed according to clinical manifestations, and generally does not require auxiliary diagnosis.

1. X-ray examination: objective evaluation of the diagnosis of the degree of deformity of the clubfoot and the therapeutic effect. The anterior and posterior position of the foot and the extreme lateral extension of the lateral slice were compared between the two sides of the foot. The anterior position of the child with the clubfoot showed that the talus talus overlapped and both of them approached the fifth metatarsal, and the angle of the heel disappeared.

2. B-ultrasound: It is a routine examination that can be used to diagnose infantile clubfoot. It has an irreplaceable role in the observation of cartilage.

3. MRI and CT scans are also recommended for preoperative and postoperative assessment of congenital clubfoot deformities, but most patients do not need these tests.

Differential diagnosis

1 neonatal foot varus:

Neonatal foot varus is similar to congenital clubfoot. Most of them are on one side. The foot is horseshoe varus, but the medial aspect 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 clubfoot:

The horseshoe foot caused by nerve changes gradually changes with the child developmental malformation. It should pay attention to the changes of intestinal and bladder function, and there is no numb area on the lateral side of the foot. Pay special attention to the pigmentation of the lumbosacral sinus or sinus and skin. An MRI should be performed to determine the presence of a tethered cord. Electromyography and nerve conduction function tests are helpful for understanding nerve damage.

3 post polio foot horseshoes:

At the time of birth, the appearance of the foot was not deformed, and the age of onset was more than 6 months. There was a history of fever. Unilaterally seen with long and short tibia tendon, early fixed deformity, normal bowel movements, can have other muscle spasms.

4 cerebral palsy after the horseshoe foot:

Perinatal or postnatal hypoxia history, most of the abnormalities found after birth, the clubfoot deformity gradually grows with the growth, but can disappear or reduce during sleep. Once stimulated, the deformity is more obvious. Horseshoe-based, less inversion, no adduction, deformity mostly bilateral or ipsilateral upper and lower limbs, lower limbs cross-gait lower extremity tendon is obvious, accompanied by mental decline.

5 multiple joint contractures:

The clubfoot is bilateral, and the foot deformity is part of multiple joint deformities of the whole body. Most of the muscles in the whole body are atrophied, hardened, fat is relatively increased, the horseshoe foot is stiff, difficult to correct, and the hip and knee joints are often affected.

The disease can be diagnosed according to clinical manifestations, and generally does not need to be diagnosed according to X-ray examination. However, X-ray film is indispensable for judging the degree of deformity of the clubfoot and the objective evaluation of the therapeutic effect. Normal neonatal foot X-ray films can be seen in the center of the fossa of the heel, distance and humerus. The ossification center of the foot bones of the sick children with clubfoot appears later. The scaphoid appeared only after the age of 3, and the humerus was well ossified after dryness.

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