ADULT NURSING V

(OBSTETRIC NURSING)

TALIPES
 OVERVIEW

• Talipes is a congenital
deformity that develops in the
womb during the first
trimester (between 8 to 12
weeks)
• Causes an abnormal twisting
of the ankles, heels, toes and
feet .
• these incidences are known
as congenital talipes equinov
arus (CTEV) or clubfoot.
ETIOLOGY

• Cause is unknown.
• Genetic or hereditary
element
•  Positioning of the foot
when it is in the womb

 If there is too little amniotic fluid

surrounding the baby in the womb (a
condition called oligohydramnios),
there is a higher rate of talipes,
possibly due to increased pressure on
the foot
 TYPES OF TALIPES

• Talipes equinovarus - the most

common form
• Talipes equinovalgus - where
the foot points outwards and
down
• Talipes calcaneovarus - where
the foot points inwards and up
• Talipes calcaneovalgus -
where the foot points inwards
and down
 PATHOPHYSIOLOGY
• The pathophysiology of the more common
isolated form is not known and is the subject
of controversy .

• Possible contributing factors:

too little amniotic fluid surrounding

the baby un the womb ( a called
oligohydramnios)

increased pressure on the foot.

The heel is turned inwards and the whole foot

plantar fiexed.

The foot is turned outwards and upwards.

The affected foot is shorter and the calf

muscles are thinner than normal. The
position of the foot is fixed and can't be
easily corrected.
 SIGNS & SYMPTOMS
• heel is turned inwards and the whole foot plantar flexed
(bent downwards).
• The foot turns inward and downward at birth (resisting
realignment)
• The calf muscle may be smaller than normal and
underdeveloped
• Clubfoot is painless, except in elderly, arthritic patients.
In older children, clubfoot may be secondary to paralysis,
polio-myelitis, or cerebral palsy, in which case treatment
must include management of the underlying disease
• Deformity may be so extreme that the toes touch the
inside of the ankle, or it may be only vaguely apparent.
 DIAGNOSTIC PROCEDURE
• An EKG and chest x-ray will identify the most
common causes of clubbing
• A sedimentation rate, and chemistry panel
should also be done routinely.
• x-ray - a diagnostic test which uses invisible
electromagnetic energy beams to produce
images of internal tissues, bones, and organs
onto film.
• computerized tomography scan
 TREATMENTS
• Treatment is often started in the weeks following birth.

GOAL: to restore the feet to their normal position to enable

proper function as well as eliminate pain and deformity.

• Strapping and physiotherapy Strips of adhesive strapping are

passed around the foot, up the sides of the leg, and over the top of the
knee, to hold the foot in a corrected position.

• Plaster fixation The surgeon manipulates the foot into position, and
holds it in place with plaster.

•  Surgery aims to loosen and lengthen tightened ligaments and

tendons in the medial and posterior parts of the feet
 CONTS… SPLINTING
NON SURGICAL METHOD:
•The Ponseti method
begins with a series of gentle manipulations
and toe-to-thigh cast placements for the first
five to seven weeks .
•The heel-cord is cut to complete the
correction of the foot before the last cast is
applied .
•Then, the last cast is placed for three weeks,
by which time the heel-cord has healed
CAST
properly
•The French method
 consists of gentle stretching of the feet,
followed by taping to maintain their
improved position.
 NURSING MANAGEMENT
 Nursing Diagnosis: Impaired physical mobility
related to cast wear.
 Goal: A client can maintain of movement and can
perform ADL normally.

Nursing intervention:
 Assess the level of physical mobility
R-to know the level of physical mobility of the client
 Assist the client to perform ADL
R-to maintain the ADL
• Elevate the leg with pillow
R-to reduce the pain and pressure at the leg
• Encourage client on bed rest
R-to minimize the mobility and reduce anxiety

E: pt free from pain

 CONTS…

• Nursing diagnosis :Parent’s knowledge deficit

regarding condition, prognosis, treatment,
selfcare and discharge needs
• Goal :Parent’s will acknowledge feelings and
identify health ways to deal with them
Nursing intervention :
• 1) assess for the level of knowledge of parent’s
• R:to know the level of knowledge to educate the
parent’s.
• 2) review pathology,prognosis and future
expectations
• R : provides knowledge base from which parents
can make informed choices.
• 3) discuss the deformity and expected treatment
in terms the parents can understands
• R : to rule out misconceptions and to provide
accurate information about the deformity

Evaluation : the pt was able to acknowledge

feelings and identfy health ways to deal with
them