Congenital clubfoot - 11 causes, what treatment is there?

Sources of clubfoot

In medicine, there are the following predisposing factors for clubfoot, which are involved in the development of the congenital defect.

Mechanical impact

Cause of the disease: incorrect positioning of the baby in the womb. There is pressure from the uterine wall on the fetal ankle joint. At the same time, it provokes impaired blood circulation and deformation of the child’s limbs.

Neuromuscular effects

Causes of the disease: improper ligamentous and muscular development, which provokes a disturbance in the formation of the child’s foot.

Toxic effects

Causes of the disease: taking medications by the mother in the early stages of pregnancy.

Genetic influence

In medicine, they are of the opinion that a congenital pathological process is a consequence of a genetic predisposition to it. But this is not always observed, since the disease can also be acquired. In the latter case, the sources of the disease will be different. For example, with improper healing of an ankle fracture. In addition, this can be due to a deep burn of the ankle, a neurological disease, a tumor, or pathologies. All these reasons may be associated with impaired growth of the child’s ankle bones.

Types of clubfoot in newborns, older children and adults - degrees of pathology

1) Depending on the etiology, there are two types of the disease in question:

Congenital . It often occurs in boys and is associated with defective structure of the ligaments, feet, muscles and bones of the lower leg.
Purchased . Under the influence of certain factors and circumstances, pathological changes occur throughout life.

2) Based on the nature of pathological changes in medical sources, congenital clubfoot is divided into two groups:

Typical

This includes:

Mild form of deformity (Osten-Sacken varus contracture). Defects in muscle and bone tissues, ligaments in this pathology are insignificant. They are quite easy to eliminate through therapeutic measures.
Soft fabric uniform. The most common type of congenital clubfoot. To eliminate this deformation, a long course of treatment is required, because there are certain changes in the bones.
Bone shape. In addition to ligaments and muscles, the talus bone is involved in the degenerative process: it becomes deformed, moves forward and outward. Defective changes can be corrected through surgery.

Atypical

This form of clubfoot occurs as a result of disorders associated with the functioning of the musculoskeletal system.

Such violations include:

Arthrogryposis. A disease in which atrophy of muscle tissue occurs, multiple deformities of joints and limbs.
Dysostosis. A hereditary pathology in which bone tissue can be detected in unusual places.
The presence of amniotic constrictions in the uterus of a pregnant woman, which generally does not affect the development of the fetus. However, such constrictions can cause clubfoot in the newborn.
Osteochondrodysplasia. It is characterized by errors in the formation of cartilage tissue, which affects the structure of the skeleton.
Congenital malformation of the leg.

In the medical literature, clubfoot is also classified according to severity:

Mild degree . Existing deformities, thanks to the ankle joint maintaining its mobility, can be eliminated through therapeutic exercises and massage. To do this, it is not necessary to seek help from a professional: parents can independently perform all the necessary manipulations at home.
Average degree . Muscles, ligaments, and ankle joints are susceptible to pathological changes. This degree of clubfoot requires specialized help.
Severe degree . It occurs against the background of defects in the development of components of the musculoskeletal system. In this case, the ankle joint is completely immobilized, and surgery (and possibly more than one) is required to treat such a deformity.
Very severe . Not amenable to treatment, incl. surgical and leads to disability.

Congenital clubfoot - symptoms

With a disease such as congenital clubfoot in children, the following areas are primarily affected: the talus, joint capsule, ligaments, tendons and muscles. The latter are shortened, displaced at their points of attachment, and their underdevelopment is observed. A doctor can diagnose this immediately after the birth of a child based on the following signs:

The plantar flexion of the child's foot is deformed.
The sole is turned inward, the outer edge is lowered.
The forefoot is rotated.
The longitudinal arch is increased.

As the child ages with clubfoot, an increase in the external manifestations of congenital pathology is diagnosed. These may be: the appearance of muscle wasting of the ankle or a rapid decrease in the size of the inner ankle. In addition, it may be the presence of varus deviation of the fingers. Due to such manifestations of the disease, the child begins to walk later.

When the child begins to walk, in the presence of clubfoot, a typical gait is noted: support on the outer part of the foot. If a unilateral foot deformity is diagnosed, the development of lameness is noted. But when there is a bilateral deformity – small steps when walking. Until about two years of age, a child “waddles” when walking. Later on through the opposite foot with deformity. By about nine years of age, if a child has clubfoot, he or she is overcome by fatigue. In this case, walking is accompanied by pain.

The main causes of clubfoot – who is at risk?

There are several factors that can provoke congenital clubfoot:

Heredity. The presence of this type of foot deformity in close relatives can cause a similar defect in a newborn.
Mechanical factors : incorrect positioning of the fetus in the last weeks of pregnancy; compression of the uterus; oligohydramnios; multiple pregnancy.
Serious genetic disorders: Edwards disease, in which the 18th pair of chromosomes triples.
Errors in fetal development , which can result from several phenomena associated with the condition of the pregnant woman:
Drinking alcoholic beverages.
Tobacco smoking.
Severe and prolonged toxicosis.
Taking a certain group of medications.
Infection of the mother's body in the third trimester of pregnancy.
Acute deficiency of vitamins in the body.
Living in environmentally unfavorable regions.
Work in conditions involving regular contact with chemicals.

Acquired clubfoot is much less common than congenital clubfoot. This type of disease often makes itself felt in early childhood, although adolescents can also develop a similar deformity.

There may be several reasons for this phenomenon:

Deviations in the functioning of the central nervous system, which led to the appearance of spastic paralysis.
Injury to the lower extremities.
Severe overstrain of the musculoskeletal system due to inadequate loads.
Polio.
Burn injury to the ankles.
Acute inflammatory processes.
Spina bifida.
Pathological neoplasms in the legs or feet.
Anomalies in the development of bone tissue in a child.
Rickets.
Incorrectly selected shoes.
Improperly fused feet or legs after a fracture.

Degrees of the disease

Considering how easily passive correction of the deformed part is performed, three degrees of congenital clubfoot in children can be distinguished:

1st degree of clubfoot in a child – mild. The child’s foot is susceptible to deformation elimination.

Stage 2 of the disease - average. There is an incomplete ban on movement of the affected joint. The correction is carried out taking into account the spring resistance of soft tissues.

Stage 3 disease – severe. A sharp ban on ankle movements is diagnosed. Correction of deformities is impossible.

What is and ICD-10 code for clubfoot

Clubfoot is a congenital orthopedic anomaly. More often observed in boys (twice). Clubfoot according to ICD 10 (international classification of diseases) received code Q66. The disease can be left-sided, right-sided or bilateral. In 10% of cases it is accompanied by other developmental defects, which confirms the hereditary theory.

The disease is characterized by a violation of the static and dynamic function of the foot. Limb deformity is accompanied by three main signs:

Bringing the foot inward.
Turning the foot inward is called supination.
Flexion at the ankle - equine.

The shape and functions of the foot are impaired due to deformation and displacement of the talus.

The clinical picture is different and depends on the degree of deformation. The following symptoms are identified:

transverse flexion of the sole;
the calcaneal tubercle is raised upward;
the medial edge of the sole is raised up;
valgus deformity at the level of the knee joints;
formation of corns along the longitudinal axis;
gait disturbance: walking with small steps, sweeping movements of the arms, the feet are placed one above the other, the body is held straight, the movements are uncertain;
posture changes: lordosis increases, excessive deflection in the lower back;
the lower leg muscles atrophy.

Congenital clubfoot. Treatment

Eliminating this disease is a long and painstaking process. The main methods of treating the disease include:

Conservative treatment methods

The healing process must begin as early as possible. Conservative treatment includes:

Exercises at the initial stage of the disease

Carrying out gymnastics for a child . Gymnastics is the process of forced gradual correction of a child’s foot deformity. It is carried out in the future by fixation using elastic bandages.
A plaster brace placed on the affected feet.
Wearing special orthopedic shoes.
Course massage for a child.

Surgical treatment methods

A severe form of congenital disease in a child or lack of timely treatment may lead to the need for surgery. The main goal of the surgeon’s intervention is to eliminate the existing foot deformities as much as possible. Rehabilitation after surgery includes a physical therapy complex using strength exercises. No less useful during this period is massage and physiotherapeutic procedures (electrophoresis, laser therapy, magnetic therapy).

Varieties

As mentioned above, clubfoot can be of congenital or acquired form. The first, in turn, is primary (typical) and secondary (atypical). The congenital form is usually diagnosed in young children (sometimes before they begin to walk). The acquired type is detected in adults at any age, after one of the above factors has affected their body.

How to choose the right shoes?

Orthopedic shoes are one of the most important methods in the treatment and prevention of congenital clubfoot in children. To increase the effectiveness of shoes, it is important to wear them in conjunction with other treatment methods. These include: physical education, therapeutic exercises, massage, therapeutic baths, fixing the foot with an elastic bandage.

It should be taken into account that the child does not need to select orthopedic shoes on his own, because they will be different for each specific case.

Anti-varus shoes promote the correct position of the foot when the child walks. In addition, the load on the feet is correctly distributed. In such models there is no instep support, but there is regulation of fasteners and Velcro. And this is an additional advantage for fixing the foot.

Timely treatment helps eliminate any pathology!

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Psychosomatics of deformation

Psychosomatics is a science whose subject of study is the interdependence of mental and physical health.

Clubfoot may be a consequence of a person’s loss of a kind of support, which consists of self-confidence and loved ones. Feet are a symbol of support and movement. If a person's relationships with the people who supported him have deteriorated, the problem will affect his health. This can explain relapses of the disease.

Congenital clubfoot is determined from birth. The child may lose support - his parents. If there are constant quarrels between them, the baby does not receive parental love, which affects his health.

The article has been verified by the editors

Diagnosis and treatment

A qualified doctor will be able to immediately identify clubfoot by external signs, but to confirm the diagnosis, radiography, ultrasound and CT are additionally prescribed.

Treatment of clubfoot is only comprehensive - this is the only way to achieve a complete recovery. Appointed:

exercise therapy exercises;
foot bandaging, plaster casting or splinting;
massage for club feet;
wearing specialized orthopedic shoes.

In severe cases of the disease, surgical intervention is indicated to stabilize the condition of the foot and ankle joint.

Who develops the disease?

Everyone is susceptible to hallux valgus, regardless of age or even social status.
Most often, the problem occurs in women and it’s not only because they are not wearing the most comfortable shoes, but also because women’s connective tissues in their feet are weaker. If such a deformity is found in a newborn, then this is a congenital disease. It is diagnosed at the very beginning of life, and the reason lies in disturbances in the location and shape of the bones of the foot, which developed inside the womb.

This is due to chromosomal disorders and diseases in the mother. A lack of macro- and microelements or vitamins in the body may also be to blame.

In children, acquired foot deformity first makes itself felt around the age of 10 months or a year, when the baby is just trying to start walking.

Most often it is present in children with muscle hypotonia or simply weakened due to prematurity, frequent illnesses, especially rickets. The culprits include polyneuropathy, cerebral palsy, myodystrophy, and poliomyelitis.

In preschoolers, foot injury or staying in a cast for more than a few weeks can also trigger the deformity. Other reasons include excess weight, dysplasia, and congenital hip dislocation.

The problem can also be caused by shoes that are too soft and do not support the child’s feet well. Sometimes the disease develops if the child stands on his feet too early.

With this orthopedic disease, the arch of the child’s foot becomes flat, and its ligaments become weak, which leads to their stretching. The ankle joint necessarily moves inward, and the heels and toes move outward.

The disease can be noticed when the baby walks: he steps mainly on the inner edge of the feet. The foot itself takes the shape of the letter X. The baby complains of pain in his legs and gets tired faster than his peers. Cramps and swelling of the feet often occur.

A sick child's shoes wear down mostly on the inner sides of the sole. The disease leads not only to flat feet or scoliosis, but also to shortening of the legs, changes in the shape of the pelvic bones, and arthrosis.

In adolescents, foot deformities of this type are often found in girls who wear heels from a young age. Among the remaining reasons for the development of the disease in adolescence are excess weight and hormonal imbalances.

Another reason is growing too quickly during adolescence. The foot also grows quickly and often cannot cope with the constantly changing load. With the disease, the most pronounced symptom is difficulty in bending and straightening the leg.

At this age, treatment will be most effective and it is possible to make your feet healthy for life.

Among adults, women are most susceptible to hallux valgus. Another risk group is representatives of “standing” professions: hairdressers, salesmen.

The disease leads to deterioration of blood circulation in the foot, disruption of the innervation of its anterior section and osteoarthritis. If this disease is not treated, there is a risk of becoming disabled in old age.

Hallux valgus - rear view