Pediatrics is a critical branch of medicine that deals with the medical care and the health of adolescents, children, and infants from birth up to the age of eighteen. The body of a neonate or a child or an infant is significantly different physiologically from that of a mature person above the age of eighteen. Therefore, children require a specialized physician referred to a pediatrician who provides both medical care for healthy children who are acutely or chronically ill and preventive health services for healthy children. Genetic variance, congenital disabilities, and developmental conditions in children are the main issues that are handled in pediatrics. There are many types of pediatric diseases. This paper discusses talipes equinovarus also called clubfoot, which is a deformity of the foot and the ankle, which a baby can be born with. The paper explores possible complications, treatment, and expected outcome associated with this deformity.
Clubfoot deformity may be associated with arthrogryposis, myelodysplasia, or multiple congenital abnormalities, but can be an isolated congenital disability and considered idiopathic. Talipes is a word derived from Latin term ‘talus' meaning ankle and ‘apes' meaning foot. A baby born with talipes has the foot pointing downwards at the ankle, while the heel of the foot turns inwards. The downward position of the foot is referred to as equinus while the inward position of the heel is referred to as varus, hence the tern equinovarus. Clubfoot is a congenital deformity, which can be detected at birth. Research indicates that fifty percent of patients with talipes equinovarus have both feet affected commonly referred to as bilateral clubfoot (Cooper and Gosnell, 2015). A baby born with this deformity has tendons on the inside part of the leg shortened, an unusual shape of bones and tightened Achilles tendon. Despite the fact that the causes of talipes have not been established, genetic factors play a major role. According to Luxner (2005), the chance that a baby is born talipes from parents who have had a child with this deformity before is three to four out of one hundred. A parent who has talipes has a high chance getting a baby with clubfoot, and the risk becomes higher in cases where both parents have talipes. In addition, clubfoot is also associated with the position of the feet of the baby when the baby is still in the womb. An inappropriate position of the baby's foot in the womb also puts a baby at a risk of developing clubfoot condition. Early amniocentesis is associated with more risk in clubfoot as compared to mid-gestational amniocentesis.
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Many complications result from talipes equinovarus, key among them being an unusual appearance of the foot of the child, abnormal walking pattern, the risk of developing arthritis and the possibility of developing a callus. Without correction at an early age, the baby's foot and leg appear slightly shorter than usual with a thinner calf resulting from weak muscles. Gait patterns in children with recurrent talipes equinovarus are characterized by subtle factors leading to some patterns such as tibial torsion, which might make the child look pigeon-toed. Talipes equinovarus can also weaken bones and cause inflammation of the joints leading to arthritis. The major types of arthritis are rheumatoid arthritis and osteoarthritis. Besides, clubfoot leads to the development of callus where the skin hardens and thickens as one walks with the foot pointing downwards.
Medical practitioners have strived over the years to identify the most appropriate method of treating congenital talipes equinovarus deformity. Talipes was traditionally diagnosed after the baby is born. However, the rapid development of the technology of ultrasound has enabled talipes to be detected during pregnancy scanning before a baby is born. The most common methods of clubfoot treatment are Ponseti method, French method, and surgery. The Ponseti method entails serial manipulation, casting, and tenotomy of Achilles tendon to achieve correction of the clubfoot. The treatments start within the first few weeks of life and commonly makes use of plaster for the cast materials as well as fiberglass to achieve clubfoot correction. This method entails specialist who gently holds, stretches and moves the child's foot using hands in a position that the foot disorder is corrected as much as possible. Once the correct position of the foot has been achieved, a plaster cast is put on to hold the foot of the child in position. The plaster cast stretches from the child's toes to the groin area. The plaster cast is removed after a week and the process repeated weekly for six weeks. A small operation is conducted after these six months having observed substantial progress in the position of the foot. The purpose of Achilles tenotomy is removing tight Achilles tendon located at the back of the foot so that the heel can drop down. Just like Ponseti method, French method is a clubfoot correction method that avoids the painful surgical treatment. With French technique, a skilled physiotherapist applies constant daily manipulations of a clubfoot of a newborn. Immobilization is then done using adhesive taping to maintain the correction achieved with stretching. With French Method, the physiotherapist also strengthens peroneal muscle to sustain long-term correction. This daily treatment goes for the first two months, and then the frequency reduces to thrice a week until the baby is six months old. In cases of resistant idiopathic, syndromic, neurogenic clubfeet, and recurrent clubfeet deformities, casting and bracing may not be sufficient and these circumstances warrant the use of surgery.
Ponseti treatment of clubfoot has generated positive results than the surgical treatment. According to Bentley (2014), thirty-five out of forty-five which represents seventy-eight percent has an excellent outcome. This percentage is significantly bigger than twenty-four out of seventy-three, thirty-three percent, in other cases where similar follow-up process was done for surgically treated patients (Bentley, 2014). Although syndromic talipes equinovarus is too complicated to be treated by Ponseti, this method can improve the position of the foot and make subsequent treatment easier. In Addition, Ponseti reduces the chances of major surgery for non-idiopathic clubfoot. However, there are risks the come with the use of Ponseti technique. For example, there is a small danger of neurovascular injury during the percutaneous tenotomy. Parents to minimize the risk of recurrence must ensure compliance with bracing.
Talipes equinovarus is one of the common deformities that can be detected in children after birth. This condition does not cause any problems until the child begins to stand and walk. It is therefore, necessary for the child to be treated to save him or her from problems associated with movement, shoe size, calf size, poor self-image, and other health-related complications. Ponseti has proven to be the most effective method of correcting clubfoot deformities for most children. According to researchers, approximately seventy percent of children with talipes equinovarus get corrected using Ponseti method (Alshryda, Huntley, and Banaszkiewicz, 2017). Besides, conservative methods of treating clubfoot are preferred although surgical treatment may be necessary in resistant and recurring cases. In addition, pregnant women are advised to refrain from smoking or spending time in smoky environments and avoid drinking alcohol. Parents and medical practitioners should be observant after childbirth to detect any instances of talipes equinovarus and follow the appropriate treatment procedure in time.
References
Bentley G. (2014). Surgical Orthopaedics and Traumatology . Berlin: Springer Berlin.
In Alshryda, S., In Huntley, J. S., & In Banaszkiewicz, P. A. (2017). Paediatric orthopaedics: An evidence-based approach to clinical questions. Switzerland: Springer.
In Cooper, K., & In Gosnell, K. (2015). Foundations and adult health nursing . St. Louis, Missouri : Elsevier/Mosby.
Luxner, K. L. (2005). Delmar's maternal-infant nursing care plans . Clifton Park, NY: Delmar Learning.
