Lady Diane M.

Cabriga

BSN-III

Clubfoot
What is Clubfoot?

 Clubfoot also called congenital talipes equinovarus.

 Clubfoot is a congenital condition (present at birth) that causes a

baby’s foot to turn inward or downward. It can be mild or severe and
occur in one or both feet. In babies who have clubfoot, the tendons
that connect their leg muscles to their heel are too short. These tight
tendons cause the foot to twist out of shape.

The four types of clubfoot

• Talipes equinovarus, the most common form.

• Talipes equinovalgus when the foot points out and down.

• Talipes calcaneovarus, when the foot points in and up and

• Talipes calcaneovalgus, when the foot points in and down.

Symptoms:

If your child has clubfoot, his or her foot may have the following appearance;

• The top of the foot is usually twisted downward and inward, increasing the arch and turning the
heel inward.

• The foot may be turned so severely that is actually looks as if it’s upside down.

• The calf muscles in the affected leg are usually underdeveloped.

• The affected foot may be up to ½ inch (about 1 centimeter) shorter than the other foot.

Causes:

• Unknown.

• In some cases, clubfoot can be associated with other abnormalities of the skeleton that are
present at birth (congenital), such as spina bifida, a serious birth defect that occurs when the
tissue surrounding the developing spinal cord of a fetus doesn’t close properly.

Risk Factors

• Sex. Clubfoot is more common in males.

• Family history. If either one of the parents or their other children have had clubfoot, the baby is
more likely to have it as well. It’s also more common if the baby has another birth defect.
 • Smoking during pregnancy. If a woman with a family history of clubfoot smokes during
pregnancy, her baby’s risk of the condition may be 20 times greater than average.

• Not enough amniotic fluid during pregnancy. Too little of the fluid that surrounds the baby in the
womb may increase the risk of clubfoot.

• Getting an infection or using illicit drugs during pregnancy. These can increase the risk of clubfoot
as well.

Complications:

Clubfoot typically doesn’t cause any problems until your child starts to stand and walk. If the
clubfoot is treated, your chill will most likely walk fairly normally. He or she may have some difficult with:

• Mobility. Your child’s mobility may be slightly limited.

• Shoe size. The affected foot may be up to 1 ½ shoe sizes smaller than unaffected foot.

However, if not treated, clubfoot causes more-serious problems. These can include:

• Arthritis. Your child is likely to develop arthritis.

• Poor self-image. The unusual appearance of the foot may make your child’s body image a concern
during the teen years.

• Inability to walk normally. The twist of the ankle may not allow your child to walk on the soles of
the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or
even the top of the feet in severe cases.

• Muscle development problems. These walking adjustments may prevent natural growth of the
calf muscles, cause large sores or calluses on the feet and result in an awkward gait.

Diagnosis

• Ultrasonography

• X-ray

• CT scan
Treatments

A. Stretching and casting (Ponsenti Method)

• This is the most common treatment for clubfoot. This
treatment entails manipulating the foot into a correct
position and then placing it in a cast to maintain that position.

• Repositioning and recasting occurs every week for several

weeks. After the shape of the foot is realigned, it’s
maintained through stretching exercise, special shoes or
splinting braces at night for up to 3 years.

• For this method work effectively, you’ll need apply your

child’s braces according to your doctors specifications so that
the foot doesn’t return to its original position.

B. Stretching and taping (French Method)

This approach is also called the functional method or the physiotherapy method. Working with
a physical therapist, parents:

• This approach involves daily

manipulation of the foot , followed by the use of
adhesive tape to maintain the correct position
until the next day.

• After 2 months, treatments are reduced

to 3 times each week until baby is 6 months old.
Once the foot’s shape is corrected, parents
continue to perform daily exercises and use night
splints until their baby is walking age.

• This method requires commitment to very frequent appointments for 6 months.

C. Surgery
 Osteotomy- metal plates or screws may used to hold the foot in the correct position

D. Dennise browne brace

• Used when long leg cast is removed after 3

weeks of treatment. The bar is fit shoulder
width apart and worn full time for the 1st 2
months

Nursing Interventions

• After delivery, assess the ankle and foot for a

true talipes deformity by straightening the foot. Pseudo-talipes can be realigned to a normal
position.
 • Monitor the infant’s temperature (for those who underwent tenotomy or surgery). Fever is the
first sign of infection.

• Cautiously evaluate crying. Infants cannot voice out pain. Crying may mean hunger, wet diapers,
abdominal pain or tingling sensation from a tight cast.

• Keep the cast clean and dry by changing diapers frequently. Use a damp cloth and dry cleansers
in wiping. Water and soap causes breakdown of cast particles.

• Place a pillow or padding under the casted area to prevent cast damage and prevent sores from
heel pressure.

• For children with traction, check and cleanse the pin sites frequently.

• Explain to the parents the importance of passive foot exercises after the final cast is removed.

• Maintaining the aligned position after the cast application is essential to prevent reoccurrence.

• Administer analgesics as ordered for pain relief after a surgical correction.

• Assess coping mechanisms of family and resources available for long-term treatment.

References:

1. https://familydoctor.org/condition/clubfoot/
2. https://www.mayoclinic.org/diseases-conditions/clubfoot/symptoms-causes/syc-20350860
3. https://www.slideshare.net/saikrishnakatragadda98/clubfoot-70783901
4. https://www.slideshare.net/KevinChristianIson/club-foot
Hip Dislocation

A Hip Dislocation is a painful and traumatic injury that occurs, when the head of the thigh bone is
forced out of the socket of the hip joint, either partially or completely.

The dislocations may either be;

i. Anterior Hip Dislocations. Femoral head situated anterior to acetabulum. Most commonly caused
by impact of dashboard knee

ii. Posterior Hip Dislocations. Axial load on femur, typically with hip flexed and adducted.

Anatomy of the Hip Joint

The hip joint is a ball-and-socket joint. The ball, at the top of the femur
(thighbone) is called the femoral head. The socket, called the acetabulum,
is a part of the pelvis. The ball rotates in the socket, allowing the leg to
move forward, backward, and sideways. Smooth cartilage lines the ball
and the socket help them glide together and secure the joint.

In most hip dislocations, the femoral head of the thighbone is

forced out of the acetabulum toward the rear (posterior dislocation). Less
often, the displaced ball is pushed out forward from the pelvis (anterior
dislocation).

Causes

 Direct trauma to the hip, due to an automobile accident

 Taking part in any rough or high-impact sport
 Falling from a significant height; especially landing on one’s hip/side (or the injury occurring since
the individual is overweight)

Signs and Symptoms

 Severe pain in the hip

 Noticeable bruising, swelling
 Decreased range of motion of the hip
 Visible deformity of the hip joint.

Complications

 Permanent damage to nerves and blood vessels

 Recurrent hip dislocations (chronic hip instability)
 Degenerative joint disease (osteoarthritis)
 Temporary or permanent disruption of blood supply to the bone, which causes cells within the
affected bone to die (a condition termed as osteonecrosis, or avascular necrosis of femoral head)

Risk Factors

 Participation in high-risk contact sports, such as football, soccer, rugby

  Individuals with history of a previous hip replacement surgery
 Studies have indicated that Hip Dislocations may have a genetic component
 Excessive consumption of alcohol increases the risk of fall injuries
 Poor muscle control or weakness in the hip, resulting in falls

Diagnosis

 Physical examination: A physician will perform a thorough physical examination of the leg and
hip.
 X-ray: An X-ray of the hip joint is a common method of evaluating a Hip Dislocation. This
diagnostic test helps provide a clear image of the dislocation, shows if any bones are broken, and
is useful in identifying any other damage to the hip joint
 CT scan: A CT scan takes a series of x-ray images from several different angles. These images are
then merged to create cross-sectional images of the bones and soft tissues of the body. This allows
a physician to examine the hip joint and surrounding structures of the body
 MRI: An MRI is a more detailed scan that uses a magnetic field to produce images that allow a
physician to view any damage to the bones and soft tissue, which surrounds the hip joint.

Treatment

a. Nonsurgical treatment measures include:

 Physical therapy exercises.
 Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be
used to treat a Hip Dislocation. These medications can help decrease the pain and swelling
 Hip Spica Cast/ Posterior Mold

b. Surgical treatment measures include:

 Closed reduction: is a surgical treatment method that is used to realign the hip joint, back to its
original position without making an incision. This procedure can be performed under general
anesthesia, spinal anesthesia, or through conscious sedation with muscle relaxants
 Open reduction and internal fixation (ORIF): is a surgical procedure to realign the fractured bone,
to its original position. Surgical hardware (such as plates, screws, or rods) is then used to stabilize
the fractured bone under the skin. This procedure is only required, if any bones are also broken

Nursing Management

 The nurse and physical therapy will educate and demonstrate to the patient post-opt exercises to
increase mobilization.
 The nurse will educate the patient how to correctly how to use the trochanter roll to help hip
alignment.
 The nurse will educate the patient how to properly change positions to relieve pressure with a
little pain possible.
 The nurse will educate the patient how to properly use trapeze bar when transferring in bed.
References:

1. https://www.hss.edu/condition-list_hip-dislocation.asp
2. https://www.dovemed.com/diseases-conditions/hip-dislocation/
3. https://www.registerednursern.com/nursing-care-plan-for-hip-fracture/