Hello and welcome, everyone, to our program for physiotherapy students.
Today we are going to talk about a theme that can affect children:
the club foot
What is it ?
The club foot, also known as equine varus foot,
is a congenital condition that affects the muscles and bones of the foot.
As you can see on the screen, instead of having the typical shape of a normal foot
the clubfoot faces down and turns inward.
There are three types of clubfoot
the idiopathic, the causes are unknown and it's the most common form
the positional, which is due to an abnormal in-utero position,
and the last, the teratological which can be the manifestation of a neuromuscular disorder
Compared to epidemiology, about 1 in 1,000 babies is born with clubfoot
Idiopathic clubfoot affects boys more frequently
and is bilateral in 50% of cases.
However, as you can see on the screen
there are studies that show that there is no gender predominance.
Let's continue there and talk about the signs and symptoms,
and for that, we will join our journalist, Amanda
who investigated the subject.
Let's keep going.
Hello Amanda
Hello, Céline
Can you tell us a little bit about the signs and symptoms of the clubfoot?
Of course.
Generally,
clubfoot doesn't cause pain or discomfort until the baby or child starts to get up or walk.
It is identified on 4 typical deformations which are: equine, varus, adduct, cavus.
Okay, and at the motor level?
What can we find in club foot?
At motor level, the foot will be very rigid,
the joint doesn't allow normal movement.
This is what we see when the baby starts walking,
he'll have an unsteady gait.
If both feet are affected, he walks on his toes.
If the foot is very twisted, the child will walk on the edges of the feet.
Let's talk a bit about evolution and prognosis.
What is the medical prognosis?
The prognosis is generally favorable, if the treatment is early
but without treatment, the correction cannot be spontaneous.
Okay, what about the functional level?
At the functional level, it is the same thing, without treatment there is no spontaneous correction
and this will have repercussions on the independence of the patient.
Okay thank you so much
Treatment should begin immediately after birth.
For orthopedic treatment, the Ponseti method is often used.
Some studies have compared this method with another treatment
and have concluded that it is an effective method that reduces the number of surgical procedures.
Another study of twelve articles on this method concludes that it is an effective treatment to correct clubfoot.
Surgery is indicated
only if the normal position of the foot
has not been reached with the Ponseti method
or other conservative treatments before the age of three months.
The aim of the operation
is to obtain a total correction of the foot
when the child reaches walking age.
After the procedure,
a cast is applied and once removed,
the child must wear soles
the child must wear special soles or shoes for at least one year.
The Ponseti method has proven to be very effective in clubfoot management.
So we go to France to visit a clubfoot specialist.
Come in!
Hello!
Hello, nice to meet you Amanda.
Nice to meet you.
Sit down!
thank you very much
So we are in the clinic of Olivier
specialist of clubfoot
and we would like to have more information in relation to our investigation
and especially compared to the Ponseti method
So the Ponseti method is the "gold standard" of treatments for the club foot
it is the reference in the field.
It applies for idiopathic clubfoot
so the causes are unknown
these are clubfoot for which we have no explanation
It breaks down into three stages:
Okay, and what are these three steps?
The first step is a correction step
therefore of manual therapy of the club foot
to put it, in the physiological axis
Okay
We correct with gentle and precise foot mobilizations.
At the end of the session, we secure the foot with a cast,
who will fix the correction.
It should also be known that this technique applies during fourth at eight week
Okay
In some cases a tenotomy is performed, it's a section of the Achilles tendon
Compared to cast,
so here I have three casts at different stages.
So the first cast, at the primitive stage of the disease, we can see it well in inversion.
Second cast, in a neutral position which corresponds to a median stage of the disease,
more central.
And we must arrive normally, at the end of the treatment, almost in eversion.
We will have a cast in eversion, that is to say in external rotation, abduction and dorsal flexion.
So here for the casts, for the evolution of the treatment of the first stage
The second stage is organized around a splint of Denis-Browne,
it is a splint that fixes the correction to avoid recurrences,
in reverse position of the club foot.
And depending on the age, it will be put on a child at least two years,
for the splint to be effective,
as the article on the screen shows
Okay. And for the last step?
And the third step is a follow-up step,
so we have more or less finished the treatment,
We are in control monitoring.
So there, once or twice a year, the child will come to be controlled by a medical team.
The follow up is until the age of adolescence,
around 14 years old for girls
and 16 years old for boys.
Until the end of bone growth
After that, treatment following the Ponseti method is normally completed.
So after these indications, compared to the Ponseti method
I imagine there is a physiotherapy treatment adapted. Can you tell us about it?
Can you tell us about it?
Yes, of course
There exist a physiotherapy treatment,
which will take place in several exercises,
therefore passive mobilizations
in the opposite directions of the club foot
stretching to flexibilize the whole musculature,
strengthening of foot's everters muscles
and also contention
in the form of splints, plasters or bandages.
It should be known that this physio treatment can be very effective
and recent studies show that after one year of physiotherapy
we can have very satisfactory results.
Okay, so it's really encouraging anyway
And thank you for your participation Olivier.
thank you
Goodbye
Clubfoot is a common orthopedic deformity
There is no cure, however
with early management, appropriate treatment and regular follow-up,
the correction of the foot of the child will allow him to live like the others.
Thank you for your attention for this first video,
we hope you liked the video!
We are waiting you for the next !
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