congenital horseshoe varus foot are common birth defects and common deformity of bone and joint in children, children and adults is one of the common causes of bone and joint functional disability. Often hear the question: what is congenital horseshoe varus foot?
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disease is introduced:
congenital horseshoe varus foot ( Congenital Clubfoot，CCF) Is one of the common neonatal congenital joint deformity. There are differences in different countries and ethnic incidence, about 0. 53‰ – 6. 8‰ About 1/1000 of that, the incidence of morbidity in live births,65 % of children for boys, bilateral prevalence rate is as high as 30% 40%, have a family history of, the risk for the newborn about 30 times higher. Equinus not embryonic malformation by normal foot into equinus, generally occur during pregnancy, 4 & ndash; During June. Rarely seen ultrasound fetus have equinus 16 weeks ago. Therefore, equinus is a kind of developmental malformation.
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the cause:
it is not clear, there are genetic factors. The horseshoe varus foot may be a neurogenic disease. Neuromuscular disease make calf, three groups of the tibialis anterior muscle and fibula muscle imbalances and produce horseshoe varus foot, spinal cord lesions is unclear, however, muscle change to secondary lesions also hard to say. Limb crus muscle atrophy may be related to the endplate degeneration and regeneration childish endplate low function.
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clinical manifestations:
after the birth of the foot which appeared varying degrees of horseshoe varus deformity, one is often lighter. Childbirth soft tissue, gimmick can correct most or all of the deformity, but release after hand deformity appeared again. A few children born after the foot bone change, more difficult to correct. In plantar flexion movement easy, strength strong, back stretch eversion difficult. The dorsalis pedis can feel from to bone, foot inside concave, convex, the lateral plantar flexion position, the front foot adduction. Children with difficult stand, walk delay, claudication, standing the lateral foot or feet is carrying load. Age is a bit long, stiff joints, and soft tissues technique can’t correct, small, thin leg, muscle atrophy, but feel normal. 5 – Form stiff, fixed deformity after 6 years of age, skeletal deformation, tough, so early detection, early treatment is very important to prognosis.
congenital horseshoe varus foot deformity consists of four parts: foot plantar flexion, strephenopodia after forefoot adduction, and high arches.
there is a clear equinus categories:
never cure type ( Equinus) under the age of eight ;
cure type ( Cured by pan plug twips) ;
type recurrence ( Cured after recurrence after spin on its front feet and the horseshoe hind) ;
stiff type ( With the stiffness of the other syndrome equinus, such as congenital multiple joints contracture disease) ;
atypical ( Short, thick and rigid, a foot and ankle deep concave fall, after the first metatarsal short, MTP joint hyperextension) 。
the principle of the treatment of the disease, which is: early detection, early diagnosis, early treatment.
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treatment goals:
have enough strong, flexible, and painless.
initial treatment should nonsurgical treatment, of which the most widely used method is the Ponseti method ( The gold standard) That was born in children with diagnosis of horseshoe varus foot can begin after 1 week treatment, 1 times a week correction technique and a plaster cast, 4 ~ 6 times gypsum ( A typical need more) Suffer the Achilles tendon after amputation ( More than 90% of this operation is required) And plaster fixation, postoperative the gypsum stay for three weeks. After wearing a connecting rod of outreach support have continued to children aged 4 ~ 5.
the gentle massage, good shape, and is the key to successful treatment, ponseti sequence a plaster cast concrete operation steps:
1, the first by lifting the first metatarsal correcting high bow;
2, through the lever of the first metatarsal extorsion CPU ( With FIFA fit) ( To correct adduction and overpronate) ;
3, outside the CPU, resist is apart from the bones, the front feet not excessive back stretch, let the CPU can be free from the bone outreach, are not allowed to touch with bone;
4, gypsum, knee-length, make relative to the CPU from tibial phil joint in vitro, continue to pull the medial plantar soft tissue from a bone.
the following by repeated a plaster cast for CCF to gradually change the appearance:
in the end, the need to rely on to maintain corrective effect (with a dressing Postoperative deformity easy relapse within 2 years) 。
the first use of a principle:
1, comfortable, appropriate;
2, lateral outreach 60 degrees, the contralateral outreach 30 degrees, the ankle 10 degrees;
3, two shoes with shoulder width apart.
wear time requirements:
1, the first 3 months of not less than 23 hours a day.
2, after wearing 12 hours a day, The night is given priority to) Age 4 – to children 5 years old;
3, late walk normally, follow-up to 18 one full year of life.