Clubfoot
Clubfoot , also called equinovarus , is a congenital (present at birth) foot . Affects the bones , muscles , tendons and blood vessels , and can occur in one or both feet.
The foot has a short and broad in appearance and the heel points downward while the front is rotated inward. The Achilles tendon is usually tense and the muscles of the calf are smaller compared with normal lower leg .
Clubfoot has an incidence of 1 per 1000 births. There are about 120,000 new cases each year worldwide . The causes that cause is unknown, but may be hereditary and can be caused by genetic factors. It has a two-fold higher incidence in men than in women.
Treatment
Studies of long-term monitoring of clubfeet surgically treated, show poor results, including weakness, stiffness and early arthritis. Dr. Ignacio Ponseti developed in the 50´s a treatment that is the most used today. This study provides a basis for considering that the Ponseti method for treating clubfoot is the best alternative. It is recommended that the Ponseti method is started as soon as possible after diagnosis, even from the first week of life. Most cases of clubfoot in infants can be corrected in 2- 3 months with this method.
Use of the splint
The genes responsible for clubfoot deformity are active from week 12 to 20 of intrauterine life until the age of 3 to 5 years. For this reason and to avoid "RELAPSE", the splint is placed immediately after removal of the last cast, about three weeks after tenotomy.
The abduction splint consists of a pair of boots, neutral or separating shape, open in the front that are attached to a bar. In unilateral cases, the boot on the affected side is set to 60-70 degrees of external rotation and the healthy side to 30 degrees. In bilateral cases the boots are set to 70 degrees in both feet.
The separation between the boots is the distance between the outside shoulder.
In some cases there may be some dorsiflexion at the bar. The splint should be worn at all times, day and night, except one hour during the shower for 3 months after cast removal of the tenotomy. After this period, the splint is worn 14-16 hours a day (at night and during naps) until the age of 3-4 years.
Types of Splints
In Institut Sant Joan we use 2 types of splints:
- The classic Dennis Browne, with rotation and the bar corresponding to the length equal to the amplitude of shoulders
- System MD Orthopedics, USA, distributed by the English company c-prodirect. It is a system developed by Mr John Mitchell which consists of a well molded plastic footplate and three soft leather straps.The foot is held securrely to the footplate and there is no slippage. The telescopic bar allows lengthening as the baby grows up. Boots are removable.
- And Alfa Flex Brace System: the German system has two advantages over the classic Dennis Browne, the first is that the boots are not permanet attached to the bar, which are much more comfortable to put on. The second is the telescopic bar, which grows with the child, always taking the distance of the shoulders properly. Also the boot is more padded. The biggest disadvantage is the cost, which is higher than in the Dennis Browne.
In the following photos you can see, first, Dennis Browne splints, and then 2 pictures of MD orthopedics, USA splints and 2 pictures with Alfa Flex Brace System:
