Many a times we come across children born with inward rotation of foot with no other abnormality present in the child. Most of the parents do not notice the problem until the child is two months old. There can be various reasons for this issue . This condition is otherwise known as Congenital Talipes Equinovarus (CTEV). This can result in long term deformity , but early management can cure the case. This article will include only the early diagnosis, conservative management and cure of club foot .
This can occur due to –
- Muscular changes like contracture.
- Neurological issues like spina bifida.
- Bony problems like absence of lower leg bones i.e-Tibia, Fibula.
- And sometimes Idiopathic with no apparent cause .
Conservative management through physiotherapy and home based manipulation by the mother can help reduce the problem.
Physiotherapy treatment protocol in hospitals and centres includes-
- Sessions including child, parent counseling,
- Knowing the history of childbirth and type of delivery,
- Assessment, Evaluation and respective physiotherapy techniques to be followed,
- Strengthening of the weak muscles,
- Stretching of the tight muscles of leg,
- Electrotherapy manoeuvres used like- Muscle stimulation, Ultrasonic therapy, Short Wave Diathermy,
- Play therapy should be included with involvement of the child in a posture of legs in the corrected position, this should be done with assistance of the physiotherapist,
- Walkers, Braces, standing frames can be used during the physiotherapy session to correct the club foot.
This treatment of choice is used in infants less than 6 months of age. First 6 months after birth , the physiotherapist advices for splinting . After removal of the splint, bracing can be done individually in day time (Phelps Brace) and in night (Dennis Brown) for 6-18 months.
At home, the mother is trained to carry out the passive manipulation of the foot everyday. It can be started right after 2 months of birth.
The procedure for manipulation is as follows-
- Forefoot Adduction- Stabilisation of the heel with one hand is done and the other thumb is placed on the talus (ankle joint), and using the ankle joint as the fulcrum , the forefoot is slowly taken outward .
- Inversion- This is corrected next by the method mentioned above by exerting pressure over the under surface of the 4th and 5th toe heads.
- Equines- This is the last to be corrected. The hand is placed beneath the foot and is raised upward.
This method should be done twice everyday by the mother . The child should be placed on the lap or lying on bed.
The physiotherapist should advise the mother to engage the child in all kinds of functional activities at home which involves using the legs in the corrected position , and avoid extra pressure and stretch over the joints . Such kind of activities can reduce the problem up to maximum possible limit in children within 5 years of age and can bring the normal bio-mechanical alignment of the leg. This creates an emotional bond between the mother and child which helps the mother to understand her child’s physical and mental status more keenly.