«Clumsy Bear" - a phrase in adults and children is very different associations: cute character from a fairy tale, a brand of delicious sweets from childhood, various songs and poems for children.But when the doctors diagnosed "club foot" kid whose parents no longer understand what it is and where it came from.Consider this article the phenomenon of clubfoot in children, will talk about his symptoms and treatment, which is prescribed by doctors. Content
Clubfoot - a fairly common defect of the musculoskeletal system, which is in the wrong position of the foot;while kids can not fully put the leg on the floor.
anomaly can be unilateral or bilatera
typical form clubfoot occurs due to a defect in the development of muscles, ligaments and tendons.This pathology is usually not beyond the foot and is divided into three types:
atypical forms clubfoot occurs as a consequence of serious violations of the musculoskeletal system:
disease differ in the degree of clubfoot:
congenital defect is not so difficult to seealready at 16 weeks fetal development when ultrasound is performed.At birth, the baby neonatologist may notice signs of clubfoot.Suffice four main symptoms to diagnosis:
There are a few additional features:
cause of congenital clubfoot can be many.
mechanical reasons , which arise because of the strong pressure on the foot wall of the uterus the fetus.Most often it manifests itself in the oligohydramnios and wrong position of the fetus in the uterus (postural clubfoot).
Genetic causes , such as Edwards syndrome, a hereditary disease that occurs due to the tripling of the 18th pair of chromosomes, and is characterized by multiple malformations.In the diagnosis of clubfoot in any case we can not exclude a hereditary factor, when the family had already been incidents of the disease among the older generation.
Neuromuscular causes (pathology fetal):
Violation setting foot in healthy children begins to manifest itself in 2-3 years, while gradually developing such symptoms:
have acquired clubfoot, like congenital lottheir reasons:
Clubfoot develops due to the increasing load on the legs of the child.He gains weight, the bones grow quickly change shape, while the muscles and tendons develop more slowly and does not keep up with them.Therefore, certain muscle groups are in an elevated tone, while others are completely relaxed.This manifests itself in the form of a foot deformity.
Do not let the disease take its course, hoping that everything goes with age.Clubfoot is not only accompanied by other diseases of the musculoskeletal system (flat feet, scoliosis), launched the disease can lead to disability and a number of complications:
congenital clubfoot can be diagnosed during pregnancy by ultrasound or in the first month of life the baby during the inspection at the doctor.Attentive parents themselves may notice that the child with legs is not all right, and turn to a pediatrician or pediatric surgeon.
acquisition of clubfoot is also easily possible to diagnose on the basis of specific complaints of parents.Then the doctor must carefully felt his foot and toes, checking their performance and determining the severity of the disease.
most reliable methods of examination that would confirm the diagnosis, ultrasound can be called a foot and a CT scan.
should be noted that X-ray picture is not always informative, because it can not reflect the whole picture completely.And all because of the small bones in the child has not yet been formed and composed of cartilage, which is clearly a picture is never seen.
Basic principles of successful treatment of any type of clubfoot:
All conservative therapies are directed not only to correct the defect, but also to consolidate the results of therapy.
diagnosis of congenital club foot is placed back in the hospital.Approximately one week after birth can start its treatment.It is carried out in an outpatient setting under the supervision of a podiatrist.But sometimes an in-patient or spa treatment.
foot kid fixed plaster cast, which changes every week as long as there is no progress - the maximum possible correction of the foot in the form of deformation, which was raised in the diagnosis.It's the best and easiest treatment option, since the bone at this time is still soft and easily adjusted.After removing the plaster, as well as to prevent recurrence, specially made for kids longetu that wear only at night.
Many doctors follow the methodology proposed Vilna.It is effective for treating not only infants toddlers and older children.In such combined therapy results are achieved in 2-3 times faster than the treatment only gradually cast.Moreover, a technique often helps when ready orthopedic surgical procedures.It was a great result for her so many like surgery and orthopedics.
main directions of therapy Vilna:
The most common treatment in our country is considered to be phased plastering.First, an orthopedic surgeon gently flexing the leg kid (without power devices).As soon as she begins to give in a little bit, the surgeon puts a plaster cast in the form of a boot.Her baby is about a week.At the next
the doctor remove the plaster, orthopedist again flexing the leg, gradually correcting its position, which again recorded another plaster "boot."And so a few times, as long as the doctor will not achieve the desired result of the correction of the foot.Such treatment is carried out during the year, together with applications of wax, and then the kids are advised to wear orthopedic shoes to fix the result.
There are many other methods of treatment of clubfoot.In addition to the use of plaster casts soft bandaging, the imposition of tires and Longuet to immobilize the joint.And drug treatment Botox.
Botox - a drug containing botulinum toxin type A that affects the nerves.So, if clubfoot Botox is injected into the calf muscle, causing muscle relaxation.In about a week the Achilles tendon weakens.This allows the foot in the correct position for 1-1,5 months.
effect of the injection is maintained about 3-6 months.Despite the fact that, in contrast to surgery, Botox is different so long acting, it allows correct foot defects lungs without scars and prolonged painful procedures.If necessary, the injection can be repeated.
But we should remember that the method of treatment always depends on the severity of the disease, its causes, the child's age and individual characteristics of the organism.It is selected by a doctor after an adequate assessment of the baby.
The first thing to determine and correct the cause of the disease.
Further, as in the treatment of congenital clubfoot, the fixation is carried out, is assigned a set of exercises and massage.Older children help with special orthopedic shoes and shoe tough backdrop that captures the ankle.
Treatment usually takes 2-4 months.In the year of the course is necessary to 3-4 until the problem is corrected clubfoot.
older children, doctors strongly recommend sports: swimming, dancing, snowboarding or skateboarding.
If conservative treatment fails, a child running or heavy form of the disease, surgery is performed.
resorted to surgery in cases where foot refuses to accept the normal position, despite all the measures taken, or if the child's severe pathology, which is not subject to conservative treatment.In such cases, surgery is necessary to correct the ligaments, tendons and joints of the foot and ankle.
congenital clubfoot is desirable to adjust when the child is 8-9 months.This is due to the fact that you need to finish the treatment before the baby starts to walk.
for surgical treatment of children under one year created some author's methods, which have proved good results: the operation proposed by NNPoppies and co-authors, as well as OABatalov and IVMusikhin.
method Ponsetti - is the author's technique, developed by an American doctor.Therapy on it can begin at the age of 1-2 weeks.Please be phased plastering feet from the toes to the upper thigh.Its distinguishing feature of the national methods - the position of the foot is corrected in several planes.Therefore, for such treatment the doctor must be specially prepared.The cast at the first stage of treatment is replaced by 6-7 times, the position of the foot is gradually changing, and ligaments are stretched.When to complete correction of the defect, there is very little - a few degrees - doctor performs minor surgery on an outpatient basis under local anesthesia.Her technique is simple: a small incision of the Achilles tendon to allow the foot even more freedom.
Once the foot is correctly positioned and the wound has healed, the child begins to wear the brace (complex orthopedic footwear) to prevent re clubfoot.First, they must be worn 23 hours a day.Gradually, the time is reduced.For two years, you can wear the brace has only during nighttime sleep.
Relapses after treatment method Ponsetti are rare.In such cases, a re-phasing of gypsum (usually shorter) and again recommended to wear the brace.
This method described in the attached video:
advantages of this method are obvious.This is not only a low percentage of relapses.Such an operation is less traumatic, and the wound after it almost hurts.In this method of treatment of the foot muscles are more flexible and powerful than the traditional when any event occurs in stiffness and frequent pain in the leg.
Children aged 2-7 years held a transaction - plastic tendons of Zatsepin - another method of surgical treatment of clubfoot, resorted to by almost all surgeons.
In congenital deformation shortened or deformed leg bones on first, followed by corrective osteotomy using Ilizarov fixator: a medical device that is intended for long bone fixation.With it held distraction (tension) or compression (compression) of bone tissue.
acquisition of clubfoot should be treated by removing the defects that caused it: scars, injured muscles, nerves, tendons and ligaments.
paralytic clubfoot, which arose because of damage to the peroneal nerve and muscles, or due to poliomyelitis, eliminate by restoring the tendon or nerve damage.In this case, sometimes a tendon transplant posterior or anterior tibial muscle on the outer side of the foot.
Another type of surgery is arthrodesis.This operation, the essence of which is to fix the bones in the joint.This is achieved by its complete immobilization and increased support ability.The best result gives calcaneocuboid and subtalar arthrodesis.
In severe foot deformities due to rough scars resulting from severe burns and injuries, scars are excised and restored tendon.Then, a skin autoplasty (transplant patient's own tissue).
deformations that have arisen as a result of injury or suffering osteomyelitis, eliminate corrective osteotomy with bone-plastic operations.Often used with the compression-distraction by Ilizarov.
subsequently, for a further year after the surgical treatment, the child needs to wear special orthopedic shoes or braces, used to walk.
after surgeries, despite the obvious effect, the muscles of the foot will still become more rigid (tough, elastic), the operated leg is often sore, much weaker and less healthy foot 1-1.5 size.
Everyone knows that any better to prevent disease than to treat it.The same applies to the clubfoot.By following simple rules, you can be assured that this disease disturb the child.
To prevent congenital clubfoot should avoid the causes that can trigger the appearance of the disease:
After giving birth, add new rules:
Parents should be aware that clubfoot often accompanies other disorders of the musculoskeletal system: scoliosis, flat feet, so in nocase can not let the disease take its course, hoping that in time it will be held.
It is necessary to seek help from a podiatrist, otherwise the disease will inevitably progress.Subsequently, one leg shorter than the other can grow;limp child will not be able to fully move and play with their peers;have problems with the selection of shoes.As a result, the child may become invalid.